National classifications

Although many national classifications have been developed in the twentieth century, these did not differ essentially from those which originated in central Europe. It is impossible to describe or even list the numerous classifications used in different countries; rather, only a few are noted. (15)

In France and Scandinavia, the Kraepelinean concept of psychoses was accepted only partially or rejected. Magnan and Serieux (16) developed a classification(17) which remained restricted to Francophone psychiatry. Some disturbances like acute and chronic delusional states ( bouffées délirantes and délires chroniques) were recognized in France but were not really understood beyond the confines of French psychiatry. The French psychiatrists were particularly resistant to the Kraepelinean concept of schizophrenia, although they accepted the concept of manic depressive psychosis, perhaps because several French authors had already used similar concepts. In Scandinavia the concept of psychogenic psychoses was advocated,(19) as were early concepts of multidimensional diagnosis.(20) The special classification of psychoses according to Wernicke, Kleist, and Leonhard adopted in Germany should also be noted. (21) These authors claimed that, according to the phenomenological description of psychoses, a valid prognosis including the genetic load can be given.

Outside Europe, for example in Asia, some traditional elements were related to European concepts. In Japan, traditional diagnostic thinking was abandoned after the Meiji reformation in 1868 and European influence was accepted.(22) The Kraepelinian system was very influential for a long time in Tokyo and elsewhere. Nowadays ICD-10 and DSM are widely used in Japan. In China an attempt was made to introduce modern aspects of diagnosis into the Chinese Classification of Mental Disorders, while still retaining special traditional elements. (23) Traditionally the diagnosis of neurasthenia is used frequently; this category is not found in DSM-IV but does appear in ICD-10, which offers a broader international view.

In constructing a classification which can be used worldwide, it must be remembered that many disorders like anorexia, anxiety disorders, sexual deviations, and borderline personality disorders that are prominent in the West are not important in many developing countries, where acute psychotic episodes, hysterical phenomena, and somatisation disorders are more frequent.(24) The dualism between body and mind that dominates Western psychiatry is unknown in many traditional healing systems. Thus there are fundamental differences between ayurvedic medicine in India or traditional healing in Nigeria, for example, and modern Western medicine. Nevertheless, ICD-10 satisfies a number of needs related to psychiatry in the Third World. (24)

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