Historical review

In classical antiquity physicians had already named psychiatric disorders, like depression or confusion, and the diagnoses of the Greek physician Galen were in use until a more systematical classification was devised in the eighteenth century. In Chapter 5 of Genera Morborum, published in 1742, Carl von Linné mentions a group of major psychiatric disorders which is complemented by minor mental disorders of neurotic nature in other chapters.(2) Only 30 years later, William Cullen published his Synopsis Nosologiae Methodicae, which also described psychiatric disorders.(3) In Cullen's scheme mental disorders were part of the broad class of neurosis, a term which was used very differently later on. At the same time the German philosopher Immanuel Kant described different forms of psychiatric disorders in his Kleine Onomastik der Gebrechen des Kopfes, providing a classical description of delusional thinking. (4) Later Heinroth from Leipzig, the first German university professor of psychiatry, built up a very complicated system of psychiatric diseases similar to the botanical system developed by von Linné. He produced many interesting diagnoses but these could not be identified reliably nor was their description reproducible. (5) In France, Pinel(6) restricted the diagnostic field to a small number of psychiatric diagnoses such as mania with and without delusions, melancholia, dementia, and idiocy. He and his pupil Esquirol (7) had a strong international influence in the nineteenth century and many psychiatrists followed their system of classification. In 1845 Wilhelm Griesinger published his textbook (8) in which he claimed that psychoses were basically only a single disorder, although he distinguished different stages and different clinical manifestations. Thus in the eighteenth and nineteenth centuries there were many different approaches to classification emerging from different backgrounds and focusing on different aspects.

In 1854 Falret(9) described folie circulaire, essentially the modern bipolar disorder, taking into account the course of the illness. The importance of the course of the disorders was emphasized by Kahlbaum(10) in 1863. Emil Kraepelin can be regarded as the most important nosologist at the end of the nineteenth century and in the early twentieth century. He described the symptoms and course of mental disorders and established types of disorder, consequently proposing two dominating psychotic disease entities, dementia praecox and manic-depressive disorder, in addition to several others described in his famous textbook. (U> Although his view gained worldwide recognition, Kraepelin encountered some opposition; for example, Alfred Hoche(12) demanded an alternative system of syndromes, rejecting the Kraepelinean nosological conception.

The position occupied by Eugen Bleuler(l3) can be described as intermediate between those of the nosologist Kraepelin and the syndromatologist Hoche. Bleuler was not convinced that there was only one disease entity called dementia praecox or, as he named it, schizophrenia; thus he preferred to refer to the 'group of schizophrenias'.

In Germany, authors whose thinking was dominated by a biological view of nosology created the Würzburg neuropsychiatric diagnostic scheme, (!4) which was used until ICD-8 was introduced in the 1960s. This was a rather simplistic classification and did not differentiate conditions sufficiently in either neurology or in psychiatry, let alone among psychogenic disorders.

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