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In his article 'On the question of unitary psychosis' (1926), Harry Marcuse (1876-1931) undertook a thought experiment in which he challenged clinical psychiatrists to entertain the possibility that the concept of unitary psychosis could be a useful diagnostic and nosological tool. Drawing on the psychology of Friedrich Jodl (1849-1914) and contemporary notions of energeticism, Marcuse proposed a non-empirical, 'analytic' method of overcoming growing dissatisfaction with Kraepelinian categories in the 1910s and 1920s.

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Irma Weinberg, a German-Jewish Neuropsychiatrist/Physician, authored the fourth report from the German Research Institute for Psychiatry in Munich examining the risk for dementia praecox (DP) in particular relatives of DP probands, here first-cousins. She examined 977 cousins of 54 DP probands and found a best-estimate risk of 1.4%. She conducted within-study analyses, showing a much higher risk for DP in the siblings than cousins of DP probands. She studied DP-related personalities showing a familial link between these conditions and risk for DP. She demonstrated that the risk for DP in cousins was impacted substantially by the distribution, in ancestors, of psychosis and personality abnormalities. After completing work on this article, Weinberg worked in private practice in Frankfurt, emigrating to the Netherlands in 1934, where she worked at a Jewish psychiatric hospital. In 1943, German occupiers evacuated the hospital, transporting the patients and staff, either directly to Auschwitz or, like Weinberg, to the Westerbork transit camp. On September 4, 1944, Dr. Weinberg was transported to Theresienstadt and soon thereafter to Auschwitz, where she was murdered at the age of 53. Her history raises painful questions about the relationship between genetic studies of psychiatric illness in prewar Germany and the Holocaust.

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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.

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BACKGROUND: In the 1899 6th edition of Kraepelin's textbook, wherein he first articulated his concept of manic-depressive insanity (MDI), "Melancholia" was not part of MDI but remained within separate involutional disorders. In his 1913 8th edition, involutional melancholia (IM) was incorporated into MDI due largely to a study he commissioned - a 1907 monograph written by Dreyfus: "Melancholia: A Picture of Manic-Depressive Insanity." METHOD: Through close readings of the relevant texts, we describe, in five sections, what happened. RESULTS: First, we review Kraepelin's initial position on the IM-MDI relationship, noting that his distinction was based on differences in symptoms, course of illness and outcome. Second, we examine the generally critical reception of Kraepelin's views in the psychiatry of his day. Third, we review the critical 1907 monograph in which Dreyfus examined and followed up all cases of IM diagnosed by Kraepelin while in Heidelberg. The results, he concluded, did not support any of Kraepelin's critical distinctions between the two syndromes. Fourth, we examine contemporary responses to Dreyfus's monograph, including Kraepelin's subsequent change of opinion. Finally, we review the overall process putting it in the context of the history of psychiatric nosology generally, and specifically, the nosologic project of Kraepelin. CONCLUSIONS: More than 60 years before the proposed use of validators to address nosologic questions in psychiatry by Robins and Guze, Dreyfus utilized three of their five validators to address the IM-MDI distinction: i) clinical description, ii) delimitation from other disorders and iii) follow-up studies.

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This article examines Emil Kraepelin's notion of comparative psychiatry and relates it to the clinical research he conducted at psychiatric hospitals in South-East Asia (1904) and the USA (1925). It argues that his research fits awkwardly within the common historiographic narratives of colonial psychiatry. It also disputes claims that his work can be interpreted meaningfully as the fons et origio of transcultural psychiatry. Instead, it argues that his comparative psychiatry was part of a larger neo-Lamarckian project of clinical epidemiology and was thus primarily a reflection of his own long-standing diagnostic practices and research agendas. However, the hospitals in Java and America exposed the institutional constraints and limitations of those practices and agendas.

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Emil Kraepelin's psychiatric nosology, proposed in the 5th and 6th editions of his textbook published in 1896 and 1899, did not quickly gain worldwide acceptance, but was instead met with substantial and sustained criticism. The authors review critiques of Kraepelin's work published in his lifetime by Adolf Meyer, Friedrich Jolly, Eugenio Tanzi, Alfred Hoche, Karl Jaspers, and Willy Hellpach. These critics made six major points. First, Kraepelin's new categories of dementia praecox and manic-depressive insanity were too broad and too heterogeneous. Second, his emphasis on course of illness was misconceived, as the same disease can result in brief episodes or a chronic course. Third, the success of his system was based on the quality of his textbooks and his academic esteem, rather than on empirical findings. Fourth, his focus on symptoms and signs led to neglect of the whole patient and his or her life story. Fifth, Kraepelin's early emphasis on experimental psychology did not bear the expected fruit. Sixth, Kraepelin was committed to the application of the medical disease model. However, because of the many-to-many relationship between brain pathology and psychiatric symptoms, true natural disease entities may not exist in psychiatry. Most of the ongoing debates about Kraepelin's nosology have roots in these earlier discussions and would be enriched by a deeper appreciation of their historical contexts. As authoritative as Kraepelin was, and remains today, his was only one among many voices, and attention to them would be well repaid by a deeper understanding of the fundamental conceptual challenges in our field. [AJP at 175: Remembering Our Past As We Envision Our Future April 1927: In Memoriam: Emil Kraepelin, M.D. Meyer provides an admiring but not uncritical overview of Kraepelin's career and contributions to psychiatry. "It was the unflinchingly psychiatric orientation of the man," he wrote, "that impressed and attracted physicians and students." (Am J Psychiatry 1927; 83:748-755 )].

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The nosology for major psychiatric disorders developed by Emil Kraepelin in the 1890s has substantially shaped psychiatry. His theories, however, did not arise de novo, being strongly influenced by Karl Kahlbaum and Ewald Hecker. From the 1860-1880s, they articulated a paradigm shift in the conceptualization of psychiatric diagnosis, from symptom-based syndromes, popular since the late 18th century, to proto-disease entities. This effort was influenced by parallel developments in general medicine, especially the rise of bacterial theories of disease where different syndromes had distinctive symptoms, courses, and etiologies. Their thinking was particularly shaped by the increasing understanding of general paresis of the insane. Indeed, this disorder, with its distinct course and characteristic symptoms, was paradigmatic for them. Their hope was that a similar progression of medical understanding would evolve for the other major psychiatric syndromes. Their thinking and its connection with Kraepelin's nosology are illustrated through a close reading of their essays on hebephrenia, catatonia, and cyclic insanity. Kahlbaum, Hecker, and Kraepelin shared both a commitment to a clinical research agenda for psychiatry (to utilize methods of clinical assessment and follow-up to help define disease forms) and a skepticism for the brain-based neuropathological paradigm of psychiatric research then dominant in most European centers. Understanding the historical origins of our key diagnostic concepts can help us to evaluate their strengths and limitations. It remains to be determined whether this "Kahlbaum-Hecker-Kraepelin paradigm"-defining disorders based on distinctive symptoms and course-will produce psychiatric syndromes of sufficient homogeneity to yield their etiologic secrets.

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This is the second of two articles exploring in depth some of the early organizational strategies that were marshalled in efforts to found and develop the German Research Institute of Psychiatry (Deutsche Forschungsanstalt für Psychiatrie). The first article analysed the strategies of psychiatric governance - best understood as a form of völkisch corporatism - that mobilized a group of stakeholders in the service of higher bio-political and hygienic ends. This second article examines how post-war imperatives and biopolitical agendas shaped the institute's organization and research. It also explores the financial challenges the institute faced amidst the collapse of the German financial system in the early Weimar Republic, including efforts to recruit financial support from the Rockefeller Foundation and other philanthropists in the USA.

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This is the first of two articles exploring in depth some of the early organizational strategies that were marshalled in efforts to found and develop the German Research Institute of Psychiatry (Deutsche Forschungsanstalt für Psychiatrie) in 1917. After briefly discussing plans for a German research institute before World War I, the article examines the political strategies and networks that Emil Kraepelin used to recruit support for the institute. It argues that his efforts at psychiatric governance can best be understood as a form of völkisch corporatism which sought to mobilize and coordinate a group of players in the service of higher biopolitical and hygienic ends. The article examines the wartime arguments used to justify the institute, the list of protagonists actively engaged in recruiting financial and political support, the various social, scientific and political networks that they exploited, and the local contingencies that had to be negotiated in order to found the research institute.

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This essay examines some of the research practices and strategies that the German psychiatrist Emil Kraepelin (1856­1926) deployed in his efforts to account for the significance of emotions in psychiatric illnesses. After briefly surveying Kraepelin's understanding of emotions and providing some historical context for his work in the late nineteenth century, it examines three different approaches that he took to studying emotions. First, it discusses his work in experimental psychology and his use of so-called artificial insanity to study affective disorders. It then turns to his clinical research, exploring his particular interest in the course and outcome of psychiatric disorders and then showing how those concerns related to his nosological delineation of manic depressive illness. Finally, it considers briefly how he attempted to expand his "clinical gaze," turning it outward onto larger, nonhospitalized populations in an attempt to study subclinical forms of affect or temperaments. The article argues that the inadequacies and limitations of his own experimental and clinical research practices contributed to his evolving understanding of affective disorders. In particular, they led him to expand and differentiate his understanding of manic-depressive illness so as to take greater account of premorbid symptoms or temperaments.

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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.

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This article examines the topography and "cultural machinery" of forensic jurisdictions in Imperial Germany. It locates the sites at which boundary disputes between psychiatric and legal professionals arose and explores the strategies and practices that governed the division of expert labor between them. It argues that the over-determined paradigms of 'medicalization' and 'biologization' have lost much of their explanatory force and that historians need to refocus their attention on the institutional and administrative configuration of forensic practices in Germany. After first sketching the statutory context of those practices, the article explores how contentious jurisdictional negotiations pitted various administrative, financial, public security, and scientific interests against one another. The article also assesses the contested status of psychiatric expertise in the courtroom, as well as post-graduate forensic psychiatric training courses and joint professional organizations, which drew the two professional communities closer together and mediated their jurisdictional disputes.

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PURPOSE OF REVIEW: The purpose of this review is to highlight recent English-language literature on the history of psychiatric institutions. It considers work published since 2010, as well as a few important older articles that have not yet been reviewed in these pages. RECENT FINDINGS: Developments in the last half of the 20th century suggest that psychiatric historiography might finally be able to put the mental asylum behind it. Deinstitutionalization and the diffusion of professional jurisdictions seem to have consigned institutional histories to the methodological dustbin. But these transformations have also opened new perspectives on the institutional history of psychiatry and its methodologies. This review reflects on some of the enduring historiographic potential and importance of evidence drawn from institutional settings. SUMMARY: As carceral narratives have begun to lose their paradigmatic status within psychiatric historiography, a much more nuanced picture of asylum culture is becoming visible. The history of psychiatric institutions remains an integral and productive part of psychiatric historiography.

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The paper examines the admissions practices of the German Society for Racial Hygiene (Gesellschaft für Rassenhygiene) between 1905 and 1916. It assesses the Society's changing statutes and the various charts (genealogical, anthropological, and clinical) used to vet prospective members. The Society's admissions procedures were dual-use technologies, at once serving as evidence for both the larger goals of racial science research and the narrower aims of social inclusion/exclusion. But these procedures can also be interpreted as reflexive practices by which members fashioned their sense of racial self and cultivated relations to that self. Finally, the article situates these practices in the context of histories of human experimentation, the self, and biopolitics.

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PURPOSE OF REVIEW: The purpose of this review is to highlight recent English-language literature in the history of psychiatry, with a special emphasis on the history of forensic psychiatry. It considers publications from 2008 and early 2009, as well as a few important older works that have not yet been reviewed in these pages. RECENT FINDINGS: The history of forensic psychiatry is a mixtum compositum that challenges historians to reassess their stock narratives in many different ways. Recent studies have demonstrated that the traditional research paradigms of modernization, medicalization, and professionalization fail adequately to capture the historical complexity and contingency of forensic practices and experiences. These deficits have prompted historians to set out in search of new, more hybrid historiographic strategies. Accordingly, their research is turning increasingly to the thresholds of forensic psychiatry where they are exploring how a heterogeneous array of concepts, images, and materials are exchanged and circulated in ways that shape the historical disposition of forensic psychiatry. SUMMARY: This review assesses three historiographic domains in which historians have traditionally situated forensic psychiatry. It argues that we need to be cognizant of these different domains and to recognize that enhancing our historical understanding will require us to reflect more carefully on the relationship between them.

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PURPOSE OF REVIEW: The purpose of this review is to highlight recent English language literature in the cultural and social history of psychiatry. It considers publications from 2007 and early 2008, as well as a few important older works that have not yet been reviewed in this journal. RECENT FINDINGS: Cultural and social historians of psychiatry are incorporating a growing number of historical objects into their narratives and developing new methodological techniques that can accommodate the full diversity of psychiatry's hybrid past. Increasingly, these histories are coming to be written in terms of multilateral and multivalent interactions with various other disciplines and organizations. In crafting these new narratives, historians face a confusing panoply of historical agents and events, reminding them that like the discipline of psychiatry itself, theirs too is a heterologic undertaking, grappling to understand and explain the otherness of psychiatry's past. SUMMARY: This review surveys the scholarly literature in several specific areas that have attracted the attention of historians of psychiatry in recent years. In particular, it considers work in the history of psychiatric institutions, borderline disorders, 20th-century somatic therapies, military psychiatry, and colonial psychiatry.

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In the writings of Alois Alzheimer and many of his contemporaries, complaints abounded about psychiatric hospitals not only failing to appreciate the importance of senile dementia, but also inhibiting scientific research into the nature and causes of the disorder. This article exploits these discontents in order to examine what Alzheimer and others thought to be optimal conditions for psychiatric research on dementia. It first analyzes the various institutional contexts in which Alzheimer worked during his career (especially in Frankfurt and Munich). It then traces some of the administrative and diagnostic practices that were deployed to enhance the conditions for his clinical and pathoanatomic research. Finally, it reflects on the implications of these practices for psychiatric care and patient experience.

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