Issues and problems of psychiatry from Philippe Pinel to Emil Kraeplin: origin and development of nosography (XVIII - XX centuries)

This research aims at addressing the study of psychiatry in the period between the end of the eighteenth century and the early years of the twentieth century: a period when profound changes took place, regarding medical, anthropological and social vision. From the eighteenth century to the present, different approaches to mental illness have been developed. Such approaches were related, on the one hand, to specific medical knowledge; and on the other, to different visions of the relationship between the individual and society. This period will then be investigated through the moments of continuity and discontinuity that have emerged in the research within psychiatry.
The work will develop:

1. The analysis of the scientific production - especially of the Treaties - of those authors who have made fundamental contributions to the development of modern and contemporary psychiatry: P. Pinel (1745-1826), W. Griesinger (1817-1868), E. Kraepelin (1856-1926).

2. A case study on the nosographic category of dementia.

Further analysis of primary sources will allow both to grasp the peculiarities of the authors, and to highlight the points of continuity and discontinuity that have marked the transition from a psychiatry still tied to purely philosophical visions (until the nineteenth century), to a medical practice based on the anatomical-clinical method (the scientific psychiatry of late nineteenth / early twentieth century).

The action of Pinel, who abandons the "coercive" method, marks the first part of discontinuity with prior methods. Pinel is the first to transform the traitement moral - philosophical idea already present in European countries and practice already followed in England – into a real "method", that he realized in Paris at the Bicetre hospital.

The theoretical and practical work of Wilhelm Griesinger led to a break with the method advocated by Pinel. Griesinger became a professor of psychiatry at the hospital Charité in Berlin in 1865 and structured the department of psychiatry, dedicating to the care of the sick, to teaching and research. The scientific thinking of Griesinger shifted from philosophical considerations, to a medical research on natural sciences. He assumed as central to his work the idea that mental illnesses should be addressed as brain disorders. The work of Emil Kraepelin, in conceptual continuity with that of Griesinger, assumed a central place in late nineteenth century psychiatry.
Kraepelin clearly stated the need to make psychiatry a discipline "scientifically credible." Such a "validity" could be achieved through two cognitive paths: a. the collection of clinical data during the life of the patient; b. the histological "post-mortem" analysis. Through constant research work, Kraepelin tried to improve the knowledge of nosographic categories that were still highly arbitrary. The nosology of Kraepelin’s commitment will be crucial to modern psychiatry. Finding characters of recurrence for various diseases, and correlating symptoms to specific pathologic findings - in his laboratory in Munich, a cutting-edge facility in Europe - allowed Kraepelin to publish eight editions - continuously updated – of the Manual of psychiatry that soon became the scientific reference text in Europe and overseas.

The research will examine a specific nosographic category that had a significant importance at the time - the "dementia" - considering it as a case study. A pathology classically linked to the age factor, it remained a general category until being recognised as Alzheimer's disease in the international classification of dementias.

The conceptual metamorphosis in the period of time analysed in this research, have led to outline a path - to be studied and documented in detail - from the Traitement moral to the histopathology laboratory of Munich.

Settembre 2016

Giovanni Silvano

Giulia Perini (Dipartimento  di Neuroscienze)
Francesco Bianchi (assegnista presso Dipartimento di Scienze Storiche, Geografiche e  dell'Antichità)
Stefano Canali (Scuola Internazionale Superiore di Studi Avanzati di Trieste)
Claudio Maddalena (Fondazione Groggia)
Massimo Rinaldi (Scuola Pubblica)