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Emil Kraepelin: grandfather of the DSM

Since the days of anti-psychiatry around 1970, when men like Ronald David Laing and Thomas Szasz, and films like One Flew over the Cuckoo’s Nest, accused society of being mad rather than the inmates, the classification of psychiatric diseases has returned – despite severe criticism. The ‘Holy Book’ of psychiatric disease classification is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The first version was published in 1952 (American Psychiatric Association 1952) but its rise to global significance really began in 1980, when version three of the DSM (DSM3) saw the light of day (American Psychiatric Association 1980). In DSM3 ‘Post Traumatic Stress Disorder’ (PTSD) – a disorder with its roots in the Vietnam War – was defined for the first time (or, as critics would say, it was invented). These critics certainly had a point in so far as this description of symptoms quickly came to be understood as an illness, a story similar to that of Attention Deficit Hyperactivity Disorder. However, the DSM was certainly not the first attempt to classify mental disease. For this, we must look back to the work of the German psychiatrist Emil Kraepelin (1856–1926). At the end of the nineteenth century he designed a classification in which he defined hundreds of disorders on the basis of their separate symptoms and regrouped them according to shared symptomatic patterns. His basic premise was that mental problems were not in the first instance the result of socioeconomic circumstances, but rather of somatic-biological factors. This was anything but unusual. At the end of the nineteenth century – days of nationalism, social-Darwinism, imperialism and racial enhancement – medicine, seeing itself as a scientific discipline, was dominated by the idea that ‘to measure is to know’. On one side, this can be seen in the development of bacteriology which, with the help of the microscope, made great strides in identifying disease-causing bacteria and showing them to the world. On the other side, in psychiatry skull-measurer Cesare Lombroso was, for a time, internationally lauded despite – or, must we say, because of – the racial connotations of his method (Sabbatini 1997). Added to this, western Europe was