- Email: [email protected]
Emil Kraepelin and Forensic Psychiatry
International Journal of Law and Psychiatry, Vol. 21, No. 4, pp. 343–353, 1998 Copyright © 1998 Elsevier Science Ltd Printed in the USA. All rights reserved 0160-2527/98 $–see front matter
PII S0160-2527(98)00025-9
Emil Kraepelin and Forensic Psychiatry Paul Hoff*
Introduction In the context of controversial discussions to do with psychopathological, nosological, and methodological problems in psychiatric research nowadays, interest in the history of psychiatry has considerably increased. It is generally accepted that the essential theoretical questions of modern psychiatry have been recognized, and sometimes even clearly defined as such, in the 19th or the beginning of the 20th century. Moreover, many of the problems regarding nosology in general, the postulated or questionable disease unit in psychiatry and the psychophysical relationship—the long-standing Leib-Seele-Problem—are either still controversial or unsolved today. One of the prominent figures in the history of German psychiatry is Emil Kraepelin (1856–1926) who held the chair for psychiatry at the university of Munich from 1903 to 1922. He is known worldwide in the psychiatric community for his nosological dichotomy between the two groups of “endogenous” psychoses (i.e., schizophrenia (dementia praecox in Kraepelin’s words) and manic-depressive illness). His contributions to many other fields of psychiatric research are not as well known, especially his forensic work. This paper, after providing some biographical information, shall give an overview of Kraepelin’s major theoretical concepts in general psychiatry. This is necessary to present and interprete his forensic concepts in their adequate historical and theoretical context. Biographical Background Emil Kraepelin was born on February 15, 1856 as the son of a music teacher and singer in Neustrelitz, a small town in the eastern German province of Mecklenburg-Vorpommern. In his early years his brother Karl, who was eight
*Professor, Department of Psychiatry and Psychotherapy, Technical University of Aachen (RWTH), Aachen, Germany. Address correspondence and reprint requests to Paul Hoff, Department of Psychiatry and Psychotherapy, Technical University of Aachen (RWTH), Leitender Oberarzt, Pauwelsstraße 30, D 52074 Aachen, Germany. 343
344
P. HOFF
years older and who later became director of the Museum for Natural History in Hamburg, encouraged Kraepelin’s interest in the natural sciences, especially botany. He studied medicine in Leipzig and Wuerzburg from 1874 to 1878. Already during his medical studies in Wuerzburg, Kraepelin had been working as a guest student at the psychiatric hospital under the directorship of Franz Rinecker (1811–1883). He began his professional life working for Bernhard von Gudden (1824–1886) in 1878 at the District Mental Hospital in Munich, where he stayed until 1882. Kraepelin then moved to Leipzig, where he was a co-worker of Paul Flechsig (1847–1929) and Wilhelm Erb (1840–1921). He was promoted to university lecturer there in 1883. In Leipzig, his personal and scientific relationship to Wilhelm Wundt (1832–1920) began, which later became extremely important for the further development of his concept of psychiatric research. Encouraged by Wundt, Kraepelin wrote his Compendium of Psychiatry in 1883, which became the precursor of the nine editions of the Lehrbuch der Psychiatrie (“Textbook of Psychiatry”), published between 1883 and 1927. After a short period of employment in Leubus (Silesia) and Dresden, Kraepelin was appointed professor of psychiatry at the university of Dorpat (Baltic) where he stayed from 1886 to 1891. In 1891, he took over the directorship of the psychiatric university hospital in Heidelberg. Here, as a second area of particular interest, as well as his experimental psychological work, Kraepelin focussed especially on clinical psychopathological research based on data about the course of illness, aiming at defining nosological boundaries. Apart from this field of research, Kraepelin significantly influenced psychopharmacology, transcultural psychiatry, forensic psychiatry, psychiatric genetics, epidemiology, and neuropathology. From 1903 to 1922 Kraepelin was ordinary professor of psychiatry in Munich. In 1904 he opened the new building of the psychiatric hospital of the Ludwig-Maximilian-University, whose main part is still used today. Despite the contrary situation due to World War I, in 1917 Kraepelin founded the Deutsche Forschungsanstalt für Psychiatrie (German Psychiatric Research Institute) in Munich to encourage and benefit psychiatric research as far as possible. This institution received considerable financial support from the Rockefeller Foundation and from an American banker and antiquary, James Loeb (1867–1933), whom Kraepelin had treated for some time for an affective disorder (Hippius, Hoff, & Muench, 1986; Weber, 1991). Later, after Kraepelin’s death, the Deutsche Forschungsanstalt was taken over by the Max-PlanckSociety, being renamed Max-Planck-Institute for Psychiatry. Alois Alzheimer (1864–1915), Franz Nissl (1860–1919), Korbinian Brodmann (1868–1918), Walter Spielmeyer (1879–1935), August Paul von Wassermann (1866–1925), and Felix Plaut (1877–1940) were among his coworkers during his time in Munich. Emil Kraepelin died, probably of pneumonia, on October 7, 1926 in Munich during his work on the ninth edition of the textbook of psychiatry. The Development of Kraepelin’s Basic Nosological Ideas To understand Kraepelin’s forensic arguments in their theoretical and historical context, one has to examine his basic nosological ideas. These ideas
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
345
were significantly influenced by three authors: Wilhelm Wundt, Wilhelm Griesinger, and Karl Ludwig Kahlbaum. The influence of Wilhelm Wundt on Kraepelin’s understanding of psychiatry and psychology as sciences can hardly be overestimated: Wundt’s aim was to establish psychology as a natural science that relied on experimental data. He criticized the highly speculative approach of the philosophy of nature, as, for example, developed by Schelling or Schleiermacher, but he also did not agree with materialism or with association psychology as proposed by Herbart (Wundt, 1880). There has been a lively controversy in the literature about whether Wundt directly stands in the tradition of English empiricism, as represented by John Stuart Mill (1806–1873) and Herbert Spencer (1820–1903) (Arnold, 1980; Boring, 1950; Danziger, 1990; Titchener, 1921; Pauleikhoff, 1987; Schneider, 1990). The majority of recent studies denies this kind of dependency and emphasizes Wundt’s profound knowledge of and appreciation for the so-called German idealism, especially in the Kantian version. Indeed, Wundt’s insisting on one of the central functions of “consciousness,” “apperception,” as he calls it, is reminiscent of Kant’s transcendental epistemology: For Wundt, apperception is the psychological function that intentionally connects sensory data and forms the personal knowledge about them. It is an active mental process, not a mere sensorial input or a simple additive association. For Wundt, there would be no knowledge and no science at all without that function of apperception. Wundt favored, at least in his earlier writings, a parallelistic point of view in the mind–body problem; and he postulated a certain kind of causality in mental life as well. But this forms a line of causality of its own and must not be mixed up or, even worse, identified with physical causality. Experimental research—and that Wundtian idea was obviously the most fascinating one for the young Kraepelin—may successfully be used in natural sciences as well as in psychology without ignoring the epistemological differences between the two fields. As a practical consequence, Wundt founded the world’s first laboratory for experimental psychology in Leipzig in 1879, and Kraepelin became one of his coworkers there (Kraepelin, 1987). In his later work, particularly when it came to the philosophical foundation of his monumental Völker psychologie (10 volumes; Wundt, 1900–1920), Wundt broadened his views significantly: He developed a voluntaristic, not to say idealistic, concept that has been criticized from a materialistic perspective as falling behind his previous views of psychology as a natural science. Wundt’s philosophy and psychology may well be understood as a profound effort to combine Kant’s critical impetus against metaphysical speculation and materialism with psychology that understood itself as an empirical, but nonreductionistic, study of man. Wundt’s roots in Kant’s philosophy and his very specific, very personal development of classical philosophical concepts led to a highly complex theory that was not free of contradictions and therefore was very likely to be misinterpreted. Out of this complex Wundtian “Weltanschauung” Kraepelin extracted what he regarded to be useful for the foundation of empirical research in psychiatry. This is the reason why Wundt’s psychology, viewed through the “filter” of Kraepelin’s texts, seems to be so much more unified and straight than it really is. Kraepelin simplified and in a certain
346
P. HOFF
way “smoothened” Wundt’s concept, but he did not falsify it. As for clinical psychiatry, which had never been Wundt’s field of interest, Kraepelin was mainly influenced by two other German psychiatrists, Wilhelm Griesinger (1817–1868) and Karl Ludwig Kahlbaum (1828–1899). It was Griesinger who had marked the “turning point” in the development of psychiatric conceptualization by postulating a thorough clinical and pathophysiological research based on the hypothesis that “mental illness is a somatic illness of the brain” (Griesinger, 1845). But it must be stressed that Griesinger’s theory was by no means as simple as this single statement, which is so often quoted without integrating it into its original context. Griesinger definitely held a very differentiated view on the problem of somato- and psychogenesis, although favoring the first in case of what we would call “endogenous psychoses,” or more modestly “psychoses of unknown etiology” (Heimann, 1988). Kahlbaum, however, seems to have been of even more significance for Kraepelin. Continuing the traditions of French psychopathology as represented, for example, by J. Falret (1854) and A. L. J. Bayle (1822), Kahlbaum developed a clinically oriented research method in the second half of the 19th century in Germany, especially taking the course of illness into consideration. This was believed to be a victory over the speculative concept of the so-called “romantic medicine” and therefore even more an argument for a critical distance to the position of the harsh and unreflected “somaticists,” who were no less dogmatic than some of the “psychicists.” Kahlbaum’s description of catatonia (1874) is a well-known example of his nosological approach, whereas his nosological system itself, employing many completely new terms, was not accepted in general and has not gained any significance for the development of 20th century psychopathology and nosology. But—and this was going to be the most impressive part of his theory for Kraepelin—Kahlbaum clearly recognized the methodological differences between pathological–anatomical and clinical–psychopathological work. With “progressive paralysis of the insane” as an example, he explained the way from the syndrome-course unit to the postulated etiologically based disease unit. Kraepelin took up Kahlbaum’s basic ideas and expanded them. The main result of this complex development is that Kraepelin postulated the existence of distinguishable, “natural psychiatric disease entities,” which should be searched for and studied with different scientific methods, that were regarded as having a principally equal scientific value (e.g., pathological anatomy, clinical symptomatology and course of illness, and etiological research). This concept was particularly aimed against methodological dogmatism that does not take the clinical point of view into account. Kraepelin also defended his theoretical postulate that—speaking largely theoretically and taking into consideration ideal conditions—the same “natural disease entities” would be the result, regardless of the research method. He did know, however, that the “ideal conditions” mentioned above were not present in the psychiatric research as it was actually practiced. Kraepelin had always voted clearly against the simple way of classification that only referred to manifest clinical symptomatology. This, in his view, had led to the profound confusion in 19th century psychopathology. It is crucial to take a very differentiated and close look at Kraepelin’s texts so as not to label him as just “nosologist” or “dogmatic materialist,” thus
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
347
severely simplifying the whole matter and misunderstanding Kraepelin’s intentions (Hoff, 1994). In his later papers, Kraepelin realized more and more the implications of his above-mentioned hypothesis and the discrepancy between theory and reality of psychiatric research. He made some critical restrictions concerning the diagnostic valuation of the clinical symptomatology in particular and stressed that there is no simple relationship between brain localization and brain function on the one hand and the clinical picture on the other hand. But it is important to recognize that he nevertheless did not revoke his basic nosological idea of “natural disease entities” (Hoff, 1985, 1988).
Kraepelin’s Work on Forensic Psychiatry In this context, we first have to mention the important, but often neglected fact, that Kraepelin’s psychiatry, though intended to be as independent from theoretical assumptions as possible, is intensively connected with several philosophical theories. That fact itself is not a problem. But—and that is a problem—Kraepelin adopted philosophical theories more or less implicitly. Contrary to the steadily changing clinical aspects of his nosology, he did not call into question the philosophical implications in detail once they had become an integrative part of his theory of psychiatry as a science. By doing so, Kraepelin was very likely to underestimate the implicit difficulties and contradictions within the philosophical theories themselves and, metaphorically speaking, “imported” these problems into psychiatry. As discussed elsewhere, four main concepts can be detected as underlying Kraepelin’s psychiatry (Hoff, 1992): Realism, parallelism, orientiation on the experimental (i.e., quantitative) approach, and naturalism. The first three concepts are not so relevant in our present context, realism being the philosophical assumption of nature existing completely independent from ourselves; parallelism claiming the ontologically strictly separate, but “parallel” development and structure of the mental and the physical; and the quantitative approach attempting to adopt the methods of natural sciences in psycho(patho)logy. Highly important for the forensic issue is the fourth theoretical concept, naturalism. In his early writings, especially on forensic psychiatry, Kraepelin clearly expresses his opinion that there are no such things as apriorical ideas, freedom of the will, or unchangeable moral values. Everything depends on the time and the specific sociocultural situation in which it is used. For Kraepelin, man was nothing but a part of nature, and anything man could do was a product of this natural existence. Kraepelin as representative of the evolutionary approach writes: In this context morality completely loses its absolute value, and it becomes a product of cultural and historical development; it is no longer something existing outside mankind, but is linked with the concept of human society; it is conceptualized as developed within and founded on manifold human relations. (Kraepelin, 1880; this and all following translations by P. H.)
348
P. HOFF
As for the field of religion, Kraepelin even speaks of “the idea of God, which is developing with psychological necessity” (Kraepelin, 1880). Later in his life, Kraepelin became somewhat more cautious concerning this matter, but there is no reason to believe that he substantially changed his mind. This naturalistic, “anti-metaphysical” point of view of course made Kraepelin feel sympathetic with Darwinistic and biologistic concepts, although—which should be stressed once more—he always objected to simplifying monistic theories as, for example, discussed by Ernst Haeckel (1834–1919), Jakob Moleschott (1822–1893), and Ludwig Büchner (1824–1899). His clearcut naturalism, of course, is one of the topics where Kraepelin definitely left the platform of the much more complex Wundtian psychology and philosophy, that included dualistic and idealistic elements. But Kraepelin never discussed this issue in detail, as in general he was not interested in implementing philosophical debates in psychiatric research. Interestingly enough, the controversy about whether, philosophically speaking, categories are apriorical structures or products of an evolutionary process, is still ongoing (Hundert, 1990, 1992). It is important to keep Kraepelin’s naturalism in mind when we now proceed to his forensic work. There were two major forensic consequences of this naturalism: first, the understanding of forensic psychiatry, like clinical psychiatry, as a decisively medical (i.e., quantitative) science and, second, the attempt to “naturalize” delinquency, too. The first aspect becomes clear when Kraepelin postulates a kind of basic forensic research, that erects the building of the penal code on the safest grounds that can be found for that purpose, that is the knowledge of natural sciences about the healthy and the ill human soul. . . . [And] it is of crucial importance that the idea of revenge is incompatible not only with our moral attitudes, but also with the definite achievements of the natural sciences. (Kraepelin, 1907) The second aspect, naturalization of delinquency, has its roots in Kraepelin’s very early paper on the abolition of the degree of punishment, published in 1880 when he was 24 years of age (Die Abschaffung des Strafmabes). It reaches its largest influence in the 1907 paper that (in the title) declares crime a “social illness” (Das Verbrechen als soziale Krankheit). The 1880 paper is as important as it is provoking. It is centered around the key topics of the juridical debate of that time: The liberal and idealistic doctrine had been sharply criticized by Karl Binding’s so-called “positivistic” theory, which must not be mixed up with Auguste Comte’s or Cesare Lombroso’s theories. For juridical “positivism,” punishment was “an unpleasant act against the delinquent, and nothing else.” That is how Kraepelin characterized this concept, which he criticized repeatedly. In his view, this was nothing but society’s revenge for misbehavior, but it underestimated the individual aspects of the delinquent, and, even more important, it neglected the possibility of improving his social adjustment, to “treat” him, as Kraepelin suggested. The “anti-positivistic” theory is closely linked with the name of Franz von Liszt who, from a juridical point of view, argued in favor of an individualized penal code (Kempe, 1969).
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
349
He asked for which psychological or—more in the line of “zeitgeist”—biological reasons, a person becomes delinquent. Consequently, punishment is regarded from a teleological perspective: Which kind (and length) of punishment will provide the highest probability that the delinquent will not repeat his criminal behavior? To answer these questions, which have been regarded as unscientific by juridical positivism, the judge will have to ask the psychiatric expert. Kraepelin’s arguments in the 1880 paper are situated in this context. He, too, wanted to individualize the psychiatric evaluation of the delinquent (Aschaffenburg, 1929). This, however, did not so much imply a psychological individualization, but a “medical” one: The delinquent has to be dealt with by the same methods as the mentally ill patient. And as the time of discharge from a mental hospital depends on the psychopathological status of a patient as diagnosed by the psychiatrist, the length of imprisonment, too, should be determined by the delinquent’s personal behavior. The expert to decide on these question, according to Kraepelin, should be the psychiatrist and not the judge. He puts it in a self-conscious way: I realized that the true and final purpose of any rational penal code is not to determine the degree of punishment by a certain rating system, but to improve the delinquent’s social adjustment by punishment. (Kraepelin, 1880) These arguments are systematically discussed in the 1907 paper: Here Kraepelin explicitly regards delinquent behavior, especially when repeatedly shown, as closely linked with, if not identical with “mental illness”; both are thought to have a “degenerative” etiology. Delinquency is a “social illness.” If that is so, the idea of punishment as a kind of generally accepted revenge is no longer plausible; instead, the delinquent should, if ever possible, be treated like any other mentally ill patient. From the idea of revenge against the offender to the concept of psychosocial improvement of a delinquent, who is regarded as, at least partly, “ill”: This was Kraepelin’s basic forensic position. Kraepelin’s use of terms as “social illness,” “degenerative etiology with social expression,” “social adjustment,” and “social and personal reasons” may be quite unsatisfactory for the present day reader because these terms are not sufficiently defined. The main reason for this lies in degeneration theory itself: This concept was highly influential in the second half of the 19th century, not only in psychiatry, but in medicine in general and in the social sciences (Pick, 1989). In France, it was introduced by B. A. Morel (1857, 1864) and V. Magnan (1896, 1891–1893). Its traces can easily be found in contemporary literary productions in several European languages. “Degeneration” was understood as the worsening of psychological, social and somatic functioning in one family over several generations (e.g., dysthymia in the first, bipolar illness in the second, severe and chronic paranoid psychosis in the third, and dementia in the fourth generation). This complex matter cannot be discussed in detail here, but it should be noted, that these ideas arose well before Gregor Mendel’s scientific approach to genetics in the present sense (Hermle, 1986; Liegeois, 1991) and that the vagueness of the concept itself made authors like Kraepelin use inprecise terminology mixing social, psychological and somatic aspects.
350
P. HOFF
As for forensic psychiatry, Cesare Lombroso’s criminal anthropology was of major importance (Jones, 1986; Lombroso, 1876). Here, criminal behavior is understood as a kind of phylogenetic setback: According to Lombroso, the criminal or a specific subtype of all criminals (il nato delinquente), in his view about one third of all delinquents, is not necessarily ill, but a relic of earlier stages of human development, he is an atavism. (von Engelhardt, 1983) Kraepelin actually had personal and scientific contact with what he likes to call “the Italian school of criminology” (Kraepelin, 1987), that is, with Cesare Lombroso’s theory. In 1885, he wrote a rather positive review about the German translation of Lombroso’s “Born Criminal” (Kraepelin, 1885). But—and that is often underestimated—he criticized any premature or speculative conclusions from somatic symptoms (stigmata degenerationis, as Lombroso had called them in his earlier publications) to the individual’s tendency to become criminal. Kraepelin regarded these hypotheses as unscientific because, in his view, there were not enough empirical data backing them. However, his scepticism was a methodological one. From the basic point of view, Kraepelin, of course, accepted the idea of degeneration and it stayed a central component of his understanding of psychiatry. Lombroso himself further developed his positions and suggested more differentiated, less speculative concepts than earlier in his life (Ranieri, 1969), but this process is not at all reflected in Kraepelin’s work. Kraepelinian publications (e.g., Kraepelin, 1904b)—like those of many other leading clinical and forensic psychiatrists of his time—extensively used terms out of the context of the above-mentioned degeneration theory. These terms often remind the present-day reader to the language of the national– socialists’ propaganda, like “degenerated,” “unfit for life,” and “inferior.” The complex and important matter of the development of psychiatric terminology between 1870 and 1945 cannot be discussed here in detail. But it should not be forgotten that this kind of language dominated degeneration theory in general and, of course, it made its way to the psychiatry of the last decades of the 19th century, too (Engstrom, 1991). In the context of viewing delinquency as subtype of mental illness, Kraepelin consequently favored the integration of diminished criminal responsibility into the penal code. Karl Wilmanns (1873–1945), a psychiatrist, voted for the opposite position; he feared that the forensic and juridical practice would become unpredictable and unjust by accepting a compromise between being fully and being not responsible (Wilmanns, 1927). Kraepelin, however, although he preferred to think in nosological categories, emphasized the dimensional aspect in this specific forensic context by stating “that there are no fixed, but only blurred borders between mental health and mental illness” (Kraepelin, 1904a). Even more decisively and more detailed, he argues that the rejection of diminuished responsibility would not do justice to the fact that there are large border areas between mental health and illness. The term “mental disorder,” as used by the penal code, excludes free will. . . . It has become so nar-
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
351
row that it fails in many cases, where the criminal behaviour was largely influenced by psychopathological phenomena. Here the psychiatric expert has to answer the question of a complete lack of free will negatively, if he does not want to leave it open for principal reasons; all he can do, is to present the facts to the judge, who will then be able to apply a lower degree of punishment, as far as that is allowed by the law. (Kraepelin, 1904a) This is still a controversial topic in different European countries: In Germany, for example, diminished responsibility (§ 21 penal code, verminderte Schuldfähigkeit) is separated from the complete lack of responsibility (§ 20 penal code, aufgehobene Schuldfähigkeit). In Austria, however, there is no such intermediate stage; responsibility is either fully present or not at all. It is important to keep in mind Kraepelin’s emphasizing the sociobiological aspects of delinquency much more than the individual (i.e., the psychological) ones, although he postulated an individualization of forensic psychiatry. He often referred to the biological level and to the “laws” of human behavior in order to link the discussion with the methods of natural sciences. However, he did not realize, or at least he did not mention, the enormous consequences a really strict deterministic position would have, when apodictically stating, that the criminal act is not . . . the result of an arbitrary will that is completely independent from all other influences, but is derived from the interplay of personal and social reasons with the same necessity as all the other social phenomena. (Kraepelin, 1907) Kraepelin did not want to engage himself in the philosophical debate about determinism. Instead, his aim was to reject all “metaphysical” implications in (forensic) psychiatry, like the idea of an apriorical free will and to emphasize the naturalistic quality of all social and psychological phenomena. That is what he means by his statement “that any individual human being, with all his perception and experience, his affect and striving, is the child of his predecessors, and is inescapably involved in the social system” (Kraepelin, 1907). As a consequence of his interpretation of delinquency as a kind of mental illness, Kraepelin not only favored the attempt to treat the offender, but was strictly opposed to the death penalty, which he calls a “very dubious and barbarical way of punishment” (Kraepelin 1880). Summary Kraepelin’s main positions in forensic psychiatry, that are understandable only in the context of his underlying psychiatric and, especially, nosological theory, are the following: (1) Criminal behavior, especially if repeatedly shown by the same individual, should be regarded as (or, in the strongest version possible, is) mental illness; (2) above all, this viewpoint is due to Kraepelin’s broad acceptance of degeneration theory in general, whereas he rejected simplifying concepts like Lombroso’s early hypothesis of clinically observable “stigmata degenerationis”; (3) Kraepelin voted for the acceptance of diminished respon-
352
P. HOFF
sibility to provide a more differentiated spectrum for the psychiatric expert and the judge; (4) because delinquency, in his view, was closely linked with mental illness, which should be treated instead of (only) being punished, he strictly objected to the death penalty; and (5) he suggested significantly increasing psychiatry’s influence on decisions regarding the kind and length of imprisonment.
References Arnold, A. (1980). Wilhelm Wundt—Sein philosophisches System. Berlin: Akademie. Aschaffenburg, G. (1929). Der Einflub Kraepelins auf die Kriminalpsychologie und Kriminalpolitik. Archiv für Psychiatrie und Nervenkrankheiten, 87, 87–95. Bayle, A. L. J. (1822). Recherches sur les maladies mentales. Paris. PhD Dissertation. Boring, E. G. (1950). A history of experimental psychology. 2nd edition. New York: Appleton-CenturyCrofts. Danziger, K. (1990). Constructing the subject: Historical origins of psychological research. Cambridge: Cambridge University Press. Engstrom, E. J. (1991). Emil Kraepelin: Psychiatry and public affairs in Wilhelmine Germany. History of Psychiatry, 2, 111–132. Falret, J. (1854). De la folie circulaire. Paris: Academie de Medecine. Griesinger, W. (1845). Die Pathologie und Therapie der psychischen Krankheiten. Stuttgart: Krabbe. Heimann, H. (1988). Aetiologievorstellungen in der Psychiatrie im Wandel der Zeiten. In F. Boecker & W. Weig (Eds.), Aktuelle Kernfragen in der Psychiatrie. Berlin: Springer. Hermle, L. (1986). Die Degenerationslehre in der Psychiatrie. Fortschritte Neurologie und Psychiatrie, 54, 69–79. Hippius, H., Hoff, P., & Muench, U. (1986). Murnau and the History of Psychiatry. In New Results in Depression Research (pp. 1–6). New York: Springer. Hoff, P. (1985). Zum Krankheitsbegriff bei Emil Kraepelin. Nervenarzt, 56, 510–513. Hoff, P. (1988). Nosologische Grundpostulate bei Kraepelin—Versuch einer kritischen Würdigung des Kraepelinschen Spätwerkes. Zeitschrift für Klinische Psychologie, Psychopathologie und Psychotherapie, 36, 328–336. Hoff, P. (1992). Emil Kraepelin and philosophy: The implicit philosophical assumptions of Kraepelinian psychiatry. In M. Spitzer, F. A. Uehlein, M. A. Schwartz, & C. Mundt (Eds.), Phenomenology, Language and Schizophrenia (pp. 115–125). New York: Springer. Hoff, P. (1994). Emil Kraepelin und die Psychiatrie als klinische Wissenschaft. Ein Beitrag zum Selbstverständnis psychiatrischer Forschung. Monographien aus dem Gesamtgebiete der Psychiatrie, Band 73. Berlin: Springer. Hundert, E. M. (1990). Are psychotic illnesses category disorders? In M. Spitzer & B. A. Maher (Eds.), Philosophy and Psychopathology (pp. 59–70). New York: Springer. Hundert, E. M. (1992). The brain’s capacity to form delusions as an evolutionary strategy for survival. In M. Spitzer, F. A. Uehlein, M. A. Schwartz, & C. Mundt (Eds.), Phenomenology, Language and Schizophrenia (pp. 346–354). New York: Springer. Jones, D. A. (1986). History of Criminology—A Philosophical Perspective. New York: Greenwood. Kahlbaum, K. L. (1874). Die Katatonie oder das Spannungsirresein. Berlin: A. Hirschwald. Kempe, G. Th. (1969). Franz von Liszt und die Kriminologie. In Franz von Liszt zum Gedächtnis (pp. 260– 280). Berlin: de Gruyter. Kraepelin, E. (1880). Die Abschaffung des Strafmabes. Ein Vorschlag zur Reform der heutigen Rechtspflege. Stuttgart: Enke. Kraepelin, E. (1885). Lombroso’s L’uomo delinquente. Zeitschrift für Strafrechtspflege, 5, 669–680. Kraepelin, E. (1904a). Zur Frage der geminderten Zurechnungsfähigkeit. Monatsschrift für Kriminalpsychologie und Strafrechtsreform, 1, 477–493. Kraepelin, E. (1904b). Die strafrechtliche Behandlung der geistig Minderwertigen, 27, Deutsche Juristentagung, Innsbruck 1904. Verh. 4, 418–434. Kraepelin, E. (1907). Das Verbrechen als soziale Krankheit. Monatsschrift für Kriminalpsychologie und Strafrechtsreform, 3, 257–279. Kraepelin, E. (1987). Lebenserinnerungen. In H. Hippius, G. Peters, & D. Ploog (Eds.), Memoirs. Berlin: Springer.
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
353
Liegeois, A. (1991). Hidden philosophy and theology in Morel’s theory of degeneration and nosology. History of Psychiatry, 2, 419–427. Lombroso, C. (1876). L’uomo delinquente in rapporto alla antropologia, alla giurisprudenza ed alle discipline carceria. Milano. Magnan, V. (1891–1893). Psychiatrische Vorlesungen. Deutsch von P J Möbius. Leipzig: Thieme. Magnan, V. (1896). Les dégénérés. Paris. Morel, B. A. (1857). Traite des degenerescences. Paris: Bailliere. Morel, B. A. (1864). De la formation du type dans les varietes degeneres. Paris: Bailliere/Masson. Pauleikhoff, B. (1987). Das Menschenbild im Wandel der Zeit. Ideengeschichte der Psychiatrie und der klinischen Psychologie. Band 3. Hürtgenwald: Pressler. Pick, D. (1989). Faces of Degeneration: A European Disorder 1848–1918. Cambridge: Cambridge University Press. Ranieri, S. (1969). Franz von Liszt und die positive Strafrechtsschule in Italien. In: Franz von Liszt zum Gedächtnis (pp. 156–178). Berlin: de Gruyter. Schneider, Chr. M. (1990). Wilhelm Wundts Völkerpsychologie. Bonn: Bouvier. Titchener, E. B. (1921). Wilhelm Wundt. American Journal of Psychology, 32, 161–178. von Engelhardt, D. (1983). Kriminalität zwischen Krankheit und Abnormität im wissenschaftlichen Denken des 19. Jahrhunderts. In H. J. Kerner, H. Göppinger, & F. Streng (Eds.), Kriminologie—Psychiatrie— Strafrecht. Festschrift für Heinz Leferenz (pp. 261–278). Heidelberg: Müller. Weber, M. M. (1991). Ein Forschungsinstitut für Psychiatrie. Die Entwicklung der Deutschen Forschungsanstalt für Psychiatrie München 1917–1945. Sudhoffs Archiv, 75, 74–89. Wilmanns (1927). Die sogenannte verminderte Zurechnungsfähigkeit als zentrales Problem der Entwürfe zu einem Deutschen Strafgesetzbuch, 30, Vorlesungen: Berlin. Wundt, W. (1880). Grundzüge der physiologischen Psychologie, 4, umgearbeitete Auflage. Leipzig: Engelmann. Wundt, W. (1900–1920). Völkerpsychologie. Eine Untersuchung der Entwicklungsgesetze von Sprache, Mythus und Sitte. 10 Bände. Leipzig: Engelmann.
PII S0160-2527(98)00025-9
Emil Kraepelin and Forensic Psychiatry Paul Hoff*
Introduction In the context of controversial discussions to do with psychopathological, nosological, and methodological problems in psychiatric research nowadays, interest in the history of psychiatry has considerably increased. It is generally accepted that the essential theoretical questions of modern psychiatry have been recognized, and sometimes even clearly defined as such, in the 19th or the beginning of the 20th century. Moreover, many of the problems regarding nosology in general, the postulated or questionable disease unit in psychiatry and the psychophysical relationship—the long-standing Leib-Seele-Problem—are either still controversial or unsolved today. One of the prominent figures in the history of German psychiatry is Emil Kraepelin (1856–1926) who held the chair for psychiatry at the university of Munich from 1903 to 1922. He is known worldwide in the psychiatric community for his nosological dichotomy between the two groups of “endogenous” psychoses (i.e., schizophrenia (dementia praecox in Kraepelin’s words) and manic-depressive illness). His contributions to many other fields of psychiatric research are not as well known, especially his forensic work. This paper, after providing some biographical information, shall give an overview of Kraepelin’s major theoretical concepts in general psychiatry. This is necessary to present and interprete his forensic concepts in their adequate historical and theoretical context. Biographical Background Emil Kraepelin was born on February 15, 1856 as the son of a music teacher and singer in Neustrelitz, a small town in the eastern German province of Mecklenburg-Vorpommern. In his early years his brother Karl, who was eight
*Professor, Department of Psychiatry and Psychotherapy, Technical University of Aachen (RWTH), Aachen, Germany. Address correspondence and reprint requests to Paul Hoff, Department of Psychiatry and Psychotherapy, Technical University of Aachen (RWTH), Leitender Oberarzt, Pauwelsstraße 30, D 52074 Aachen, Germany. 343
344
P. HOFF
years older and who later became director of the Museum for Natural History in Hamburg, encouraged Kraepelin’s interest in the natural sciences, especially botany. He studied medicine in Leipzig and Wuerzburg from 1874 to 1878. Already during his medical studies in Wuerzburg, Kraepelin had been working as a guest student at the psychiatric hospital under the directorship of Franz Rinecker (1811–1883). He began his professional life working for Bernhard von Gudden (1824–1886) in 1878 at the District Mental Hospital in Munich, where he stayed until 1882. Kraepelin then moved to Leipzig, where he was a co-worker of Paul Flechsig (1847–1929) and Wilhelm Erb (1840–1921). He was promoted to university lecturer there in 1883. In Leipzig, his personal and scientific relationship to Wilhelm Wundt (1832–1920) began, which later became extremely important for the further development of his concept of psychiatric research. Encouraged by Wundt, Kraepelin wrote his Compendium of Psychiatry in 1883, which became the precursor of the nine editions of the Lehrbuch der Psychiatrie (“Textbook of Psychiatry”), published between 1883 and 1927. After a short period of employment in Leubus (Silesia) and Dresden, Kraepelin was appointed professor of psychiatry at the university of Dorpat (Baltic) where he stayed from 1886 to 1891. In 1891, he took over the directorship of the psychiatric university hospital in Heidelberg. Here, as a second area of particular interest, as well as his experimental psychological work, Kraepelin focussed especially on clinical psychopathological research based on data about the course of illness, aiming at defining nosological boundaries. Apart from this field of research, Kraepelin significantly influenced psychopharmacology, transcultural psychiatry, forensic psychiatry, psychiatric genetics, epidemiology, and neuropathology. From 1903 to 1922 Kraepelin was ordinary professor of psychiatry in Munich. In 1904 he opened the new building of the psychiatric hospital of the Ludwig-Maximilian-University, whose main part is still used today. Despite the contrary situation due to World War I, in 1917 Kraepelin founded the Deutsche Forschungsanstalt für Psychiatrie (German Psychiatric Research Institute) in Munich to encourage and benefit psychiatric research as far as possible. This institution received considerable financial support from the Rockefeller Foundation and from an American banker and antiquary, James Loeb (1867–1933), whom Kraepelin had treated for some time for an affective disorder (Hippius, Hoff, & Muench, 1986; Weber, 1991). Later, after Kraepelin’s death, the Deutsche Forschungsanstalt was taken over by the Max-PlanckSociety, being renamed Max-Planck-Institute for Psychiatry. Alois Alzheimer (1864–1915), Franz Nissl (1860–1919), Korbinian Brodmann (1868–1918), Walter Spielmeyer (1879–1935), August Paul von Wassermann (1866–1925), and Felix Plaut (1877–1940) were among his coworkers during his time in Munich. Emil Kraepelin died, probably of pneumonia, on October 7, 1926 in Munich during his work on the ninth edition of the textbook of psychiatry. The Development of Kraepelin’s Basic Nosological Ideas To understand Kraepelin’s forensic arguments in their theoretical and historical context, one has to examine his basic nosological ideas. These ideas
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
345
were significantly influenced by three authors: Wilhelm Wundt, Wilhelm Griesinger, and Karl Ludwig Kahlbaum. The influence of Wilhelm Wundt on Kraepelin’s understanding of psychiatry and psychology as sciences can hardly be overestimated: Wundt’s aim was to establish psychology as a natural science that relied on experimental data. He criticized the highly speculative approach of the philosophy of nature, as, for example, developed by Schelling or Schleiermacher, but he also did not agree with materialism or with association psychology as proposed by Herbart (Wundt, 1880). There has been a lively controversy in the literature about whether Wundt directly stands in the tradition of English empiricism, as represented by John Stuart Mill (1806–1873) and Herbert Spencer (1820–1903) (Arnold, 1980; Boring, 1950; Danziger, 1990; Titchener, 1921; Pauleikhoff, 1987; Schneider, 1990). The majority of recent studies denies this kind of dependency and emphasizes Wundt’s profound knowledge of and appreciation for the so-called German idealism, especially in the Kantian version. Indeed, Wundt’s insisting on one of the central functions of “consciousness,” “apperception,” as he calls it, is reminiscent of Kant’s transcendental epistemology: For Wundt, apperception is the psychological function that intentionally connects sensory data and forms the personal knowledge about them. It is an active mental process, not a mere sensorial input or a simple additive association. For Wundt, there would be no knowledge and no science at all without that function of apperception. Wundt favored, at least in his earlier writings, a parallelistic point of view in the mind–body problem; and he postulated a certain kind of causality in mental life as well. But this forms a line of causality of its own and must not be mixed up or, even worse, identified with physical causality. Experimental research—and that Wundtian idea was obviously the most fascinating one for the young Kraepelin—may successfully be used in natural sciences as well as in psychology without ignoring the epistemological differences between the two fields. As a practical consequence, Wundt founded the world’s first laboratory for experimental psychology in Leipzig in 1879, and Kraepelin became one of his coworkers there (Kraepelin, 1987). In his later work, particularly when it came to the philosophical foundation of his monumental Völker psychologie (10 volumes; Wundt, 1900–1920), Wundt broadened his views significantly: He developed a voluntaristic, not to say idealistic, concept that has been criticized from a materialistic perspective as falling behind his previous views of psychology as a natural science. Wundt’s philosophy and psychology may well be understood as a profound effort to combine Kant’s critical impetus against metaphysical speculation and materialism with psychology that understood itself as an empirical, but nonreductionistic, study of man. Wundt’s roots in Kant’s philosophy and his very specific, very personal development of classical philosophical concepts led to a highly complex theory that was not free of contradictions and therefore was very likely to be misinterpreted. Out of this complex Wundtian “Weltanschauung” Kraepelin extracted what he regarded to be useful for the foundation of empirical research in psychiatry. This is the reason why Wundt’s psychology, viewed through the “filter” of Kraepelin’s texts, seems to be so much more unified and straight than it really is. Kraepelin simplified and in a certain
346
P. HOFF
way “smoothened” Wundt’s concept, but he did not falsify it. As for clinical psychiatry, which had never been Wundt’s field of interest, Kraepelin was mainly influenced by two other German psychiatrists, Wilhelm Griesinger (1817–1868) and Karl Ludwig Kahlbaum (1828–1899). It was Griesinger who had marked the “turning point” in the development of psychiatric conceptualization by postulating a thorough clinical and pathophysiological research based on the hypothesis that “mental illness is a somatic illness of the brain” (Griesinger, 1845). But it must be stressed that Griesinger’s theory was by no means as simple as this single statement, which is so often quoted without integrating it into its original context. Griesinger definitely held a very differentiated view on the problem of somato- and psychogenesis, although favoring the first in case of what we would call “endogenous psychoses,” or more modestly “psychoses of unknown etiology” (Heimann, 1988). Kahlbaum, however, seems to have been of even more significance for Kraepelin. Continuing the traditions of French psychopathology as represented, for example, by J. Falret (1854) and A. L. J. Bayle (1822), Kahlbaum developed a clinically oriented research method in the second half of the 19th century in Germany, especially taking the course of illness into consideration. This was believed to be a victory over the speculative concept of the so-called “romantic medicine” and therefore even more an argument for a critical distance to the position of the harsh and unreflected “somaticists,” who were no less dogmatic than some of the “psychicists.” Kahlbaum’s description of catatonia (1874) is a well-known example of his nosological approach, whereas his nosological system itself, employing many completely new terms, was not accepted in general and has not gained any significance for the development of 20th century psychopathology and nosology. But—and this was going to be the most impressive part of his theory for Kraepelin—Kahlbaum clearly recognized the methodological differences between pathological–anatomical and clinical–psychopathological work. With “progressive paralysis of the insane” as an example, he explained the way from the syndrome-course unit to the postulated etiologically based disease unit. Kraepelin took up Kahlbaum’s basic ideas and expanded them. The main result of this complex development is that Kraepelin postulated the existence of distinguishable, “natural psychiatric disease entities,” which should be searched for and studied with different scientific methods, that were regarded as having a principally equal scientific value (e.g., pathological anatomy, clinical symptomatology and course of illness, and etiological research). This concept was particularly aimed against methodological dogmatism that does not take the clinical point of view into account. Kraepelin also defended his theoretical postulate that—speaking largely theoretically and taking into consideration ideal conditions—the same “natural disease entities” would be the result, regardless of the research method. He did know, however, that the “ideal conditions” mentioned above were not present in the psychiatric research as it was actually practiced. Kraepelin had always voted clearly against the simple way of classification that only referred to manifest clinical symptomatology. This, in his view, had led to the profound confusion in 19th century psychopathology. It is crucial to take a very differentiated and close look at Kraepelin’s texts so as not to label him as just “nosologist” or “dogmatic materialist,” thus
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
347
severely simplifying the whole matter and misunderstanding Kraepelin’s intentions (Hoff, 1994). In his later papers, Kraepelin realized more and more the implications of his above-mentioned hypothesis and the discrepancy between theory and reality of psychiatric research. He made some critical restrictions concerning the diagnostic valuation of the clinical symptomatology in particular and stressed that there is no simple relationship between brain localization and brain function on the one hand and the clinical picture on the other hand. But it is important to recognize that he nevertheless did not revoke his basic nosological idea of “natural disease entities” (Hoff, 1985, 1988).
Kraepelin’s Work on Forensic Psychiatry In this context, we first have to mention the important, but often neglected fact, that Kraepelin’s psychiatry, though intended to be as independent from theoretical assumptions as possible, is intensively connected with several philosophical theories. That fact itself is not a problem. But—and that is a problem—Kraepelin adopted philosophical theories more or less implicitly. Contrary to the steadily changing clinical aspects of his nosology, he did not call into question the philosophical implications in detail once they had become an integrative part of his theory of psychiatry as a science. By doing so, Kraepelin was very likely to underestimate the implicit difficulties and contradictions within the philosophical theories themselves and, metaphorically speaking, “imported” these problems into psychiatry. As discussed elsewhere, four main concepts can be detected as underlying Kraepelin’s psychiatry (Hoff, 1992): Realism, parallelism, orientiation on the experimental (i.e., quantitative) approach, and naturalism. The first three concepts are not so relevant in our present context, realism being the philosophical assumption of nature existing completely independent from ourselves; parallelism claiming the ontologically strictly separate, but “parallel” development and structure of the mental and the physical; and the quantitative approach attempting to adopt the methods of natural sciences in psycho(patho)logy. Highly important for the forensic issue is the fourth theoretical concept, naturalism. In his early writings, especially on forensic psychiatry, Kraepelin clearly expresses his opinion that there are no such things as apriorical ideas, freedom of the will, or unchangeable moral values. Everything depends on the time and the specific sociocultural situation in which it is used. For Kraepelin, man was nothing but a part of nature, and anything man could do was a product of this natural existence. Kraepelin as representative of the evolutionary approach writes: In this context morality completely loses its absolute value, and it becomes a product of cultural and historical development; it is no longer something existing outside mankind, but is linked with the concept of human society; it is conceptualized as developed within and founded on manifold human relations. (Kraepelin, 1880; this and all following translations by P. H.)
348
P. HOFF
As for the field of religion, Kraepelin even speaks of “the idea of God, which is developing with psychological necessity” (Kraepelin, 1880). Later in his life, Kraepelin became somewhat more cautious concerning this matter, but there is no reason to believe that he substantially changed his mind. This naturalistic, “anti-metaphysical” point of view of course made Kraepelin feel sympathetic with Darwinistic and biologistic concepts, although—which should be stressed once more—he always objected to simplifying monistic theories as, for example, discussed by Ernst Haeckel (1834–1919), Jakob Moleschott (1822–1893), and Ludwig Büchner (1824–1899). His clearcut naturalism, of course, is one of the topics where Kraepelin definitely left the platform of the much more complex Wundtian psychology and philosophy, that included dualistic and idealistic elements. But Kraepelin never discussed this issue in detail, as in general he was not interested in implementing philosophical debates in psychiatric research. Interestingly enough, the controversy about whether, philosophically speaking, categories are apriorical structures or products of an evolutionary process, is still ongoing (Hundert, 1990, 1992). It is important to keep Kraepelin’s naturalism in mind when we now proceed to his forensic work. There were two major forensic consequences of this naturalism: first, the understanding of forensic psychiatry, like clinical psychiatry, as a decisively medical (i.e., quantitative) science and, second, the attempt to “naturalize” delinquency, too. The first aspect becomes clear when Kraepelin postulates a kind of basic forensic research, that erects the building of the penal code on the safest grounds that can be found for that purpose, that is the knowledge of natural sciences about the healthy and the ill human soul. . . . [And] it is of crucial importance that the idea of revenge is incompatible not only with our moral attitudes, but also with the definite achievements of the natural sciences. (Kraepelin, 1907) The second aspect, naturalization of delinquency, has its roots in Kraepelin’s very early paper on the abolition of the degree of punishment, published in 1880 when he was 24 years of age (Die Abschaffung des Strafmabes). It reaches its largest influence in the 1907 paper that (in the title) declares crime a “social illness” (Das Verbrechen als soziale Krankheit). The 1880 paper is as important as it is provoking. It is centered around the key topics of the juridical debate of that time: The liberal and idealistic doctrine had been sharply criticized by Karl Binding’s so-called “positivistic” theory, which must not be mixed up with Auguste Comte’s or Cesare Lombroso’s theories. For juridical “positivism,” punishment was “an unpleasant act against the delinquent, and nothing else.” That is how Kraepelin characterized this concept, which he criticized repeatedly. In his view, this was nothing but society’s revenge for misbehavior, but it underestimated the individual aspects of the delinquent, and, even more important, it neglected the possibility of improving his social adjustment, to “treat” him, as Kraepelin suggested. The “anti-positivistic” theory is closely linked with the name of Franz von Liszt who, from a juridical point of view, argued in favor of an individualized penal code (Kempe, 1969).
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
349
He asked for which psychological or—more in the line of “zeitgeist”—biological reasons, a person becomes delinquent. Consequently, punishment is regarded from a teleological perspective: Which kind (and length) of punishment will provide the highest probability that the delinquent will not repeat his criminal behavior? To answer these questions, which have been regarded as unscientific by juridical positivism, the judge will have to ask the psychiatric expert. Kraepelin’s arguments in the 1880 paper are situated in this context. He, too, wanted to individualize the psychiatric evaluation of the delinquent (Aschaffenburg, 1929). This, however, did not so much imply a psychological individualization, but a “medical” one: The delinquent has to be dealt with by the same methods as the mentally ill patient. And as the time of discharge from a mental hospital depends on the psychopathological status of a patient as diagnosed by the psychiatrist, the length of imprisonment, too, should be determined by the delinquent’s personal behavior. The expert to decide on these question, according to Kraepelin, should be the psychiatrist and not the judge. He puts it in a self-conscious way: I realized that the true and final purpose of any rational penal code is not to determine the degree of punishment by a certain rating system, but to improve the delinquent’s social adjustment by punishment. (Kraepelin, 1880) These arguments are systematically discussed in the 1907 paper: Here Kraepelin explicitly regards delinquent behavior, especially when repeatedly shown, as closely linked with, if not identical with “mental illness”; both are thought to have a “degenerative” etiology. Delinquency is a “social illness.” If that is so, the idea of punishment as a kind of generally accepted revenge is no longer plausible; instead, the delinquent should, if ever possible, be treated like any other mentally ill patient. From the idea of revenge against the offender to the concept of psychosocial improvement of a delinquent, who is regarded as, at least partly, “ill”: This was Kraepelin’s basic forensic position. Kraepelin’s use of terms as “social illness,” “degenerative etiology with social expression,” “social adjustment,” and “social and personal reasons” may be quite unsatisfactory for the present day reader because these terms are not sufficiently defined. The main reason for this lies in degeneration theory itself: This concept was highly influential in the second half of the 19th century, not only in psychiatry, but in medicine in general and in the social sciences (Pick, 1989). In France, it was introduced by B. A. Morel (1857, 1864) and V. Magnan (1896, 1891–1893). Its traces can easily be found in contemporary literary productions in several European languages. “Degeneration” was understood as the worsening of psychological, social and somatic functioning in one family over several generations (e.g., dysthymia in the first, bipolar illness in the second, severe and chronic paranoid psychosis in the third, and dementia in the fourth generation). This complex matter cannot be discussed in detail here, but it should be noted, that these ideas arose well before Gregor Mendel’s scientific approach to genetics in the present sense (Hermle, 1986; Liegeois, 1991) and that the vagueness of the concept itself made authors like Kraepelin use inprecise terminology mixing social, psychological and somatic aspects.
350
P. HOFF
As for forensic psychiatry, Cesare Lombroso’s criminal anthropology was of major importance (Jones, 1986; Lombroso, 1876). Here, criminal behavior is understood as a kind of phylogenetic setback: According to Lombroso, the criminal or a specific subtype of all criminals (il nato delinquente), in his view about one third of all delinquents, is not necessarily ill, but a relic of earlier stages of human development, he is an atavism. (von Engelhardt, 1983) Kraepelin actually had personal and scientific contact with what he likes to call “the Italian school of criminology” (Kraepelin, 1987), that is, with Cesare Lombroso’s theory. In 1885, he wrote a rather positive review about the German translation of Lombroso’s “Born Criminal” (Kraepelin, 1885). But—and that is often underestimated—he criticized any premature or speculative conclusions from somatic symptoms (stigmata degenerationis, as Lombroso had called them in his earlier publications) to the individual’s tendency to become criminal. Kraepelin regarded these hypotheses as unscientific because, in his view, there were not enough empirical data backing them. However, his scepticism was a methodological one. From the basic point of view, Kraepelin, of course, accepted the idea of degeneration and it stayed a central component of his understanding of psychiatry. Lombroso himself further developed his positions and suggested more differentiated, less speculative concepts than earlier in his life (Ranieri, 1969), but this process is not at all reflected in Kraepelin’s work. Kraepelinian publications (e.g., Kraepelin, 1904b)—like those of many other leading clinical and forensic psychiatrists of his time—extensively used terms out of the context of the above-mentioned degeneration theory. These terms often remind the present-day reader to the language of the national– socialists’ propaganda, like “degenerated,” “unfit for life,” and “inferior.” The complex and important matter of the development of psychiatric terminology between 1870 and 1945 cannot be discussed here in detail. But it should not be forgotten that this kind of language dominated degeneration theory in general and, of course, it made its way to the psychiatry of the last decades of the 19th century, too (Engstrom, 1991). In the context of viewing delinquency as subtype of mental illness, Kraepelin consequently favored the integration of diminished criminal responsibility into the penal code. Karl Wilmanns (1873–1945), a psychiatrist, voted for the opposite position; he feared that the forensic and juridical practice would become unpredictable and unjust by accepting a compromise between being fully and being not responsible (Wilmanns, 1927). Kraepelin, however, although he preferred to think in nosological categories, emphasized the dimensional aspect in this specific forensic context by stating “that there are no fixed, but only blurred borders between mental health and mental illness” (Kraepelin, 1904a). Even more decisively and more detailed, he argues that the rejection of diminuished responsibility would not do justice to the fact that there are large border areas between mental health and illness. The term “mental disorder,” as used by the penal code, excludes free will. . . . It has become so nar-
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
351
row that it fails in many cases, where the criminal behaviour was largely influenced by psychopathological phenomena. Here the psychiatric expert has to answer the question of a complete lack of free will negatively, if he does not want to leave it open for principal reasons; all he can do, is to present the facts to the judge, who will then be able to apply a lower degree of punishment, as far as that is allowed by the law. (Kraepelin, 1904a) This is still a controversial topic in different European countries: In Germany, for example, diminished responsibility (§ 21 penal code, verminderte Schuldfähigkeit) is separated from the complete lack of responsibility (§ 20 penal code, aufgehobene Schuldfähigkeit). In Austria, however, there is no such intermediate stage; responsibility is either fully present or not at all. It is important to keep in mind Kraepelin’s emphasizing the sociobiological aspects of delinquency much more than the individual (i.e., the psychological) ones, although he postulated an individualization of forensic psychiatry. He often referred to the biological level and to the “laws” of human behavior in order to link the discussion with the methods of natural sciences. However, he did not realize, or at least he did not mention, the enormous consequences a really strict deterministic position would have, when apodictically stating, that the criminal act is not . . . the result of an arbitrary will that is completely independent from all other influences, but is derived from the interplay of personal and social reasons with the same necessity as all the other social phenomena. (Kraepelin, 1907) Kraepelin did not want to engage himself in the philosophical debate about determinism. Instead, his aim was to reject all “metaphysical” implications in (forensic) psychiatry, like the idea of an apriorical free will and to emphasize the naturalistic quality of all social and psychological phenomena. That is what he means by his statement “that any individual human being, with all his perception and experience, his affect and striving, is the child of his predecessors, and is inescapably involved in the social system” (Kraepelin, 1907). As a consequence of his interpretation of delinquency as a kind of mental illness, Kraepelin not only favored the attempt to treat the offender, but was strictly opposed to the death penalty, which he calls a “very dubious and barbarical way of punishment” (Kraepelin 1880). Summary Kraepelin’s main positions in forensic psychiatry, that are understandable only in the context of his underlying psychiatric and, especially, nosological theory, are the following: (1) Criminal behavior, especially if repeatedly shown by the same individual, should be regarded as (or, in the strongest version possible, is) mental illness; (2) above all, this viewpoint is due to Kraepelin’s broad acceptance of degeneration theory in general, whereas he rejected simplifying concepts like Lombroso’s early hypothesis of clinically observable “stigmata degenerationis”; (3) Kraepelin voted for the acceptance of diminished respon-
352
P. HOFF
sibility to provide a more differentiated spectrum for the psychiatric expert and the judge; (4) because delinquency, in his view, was closely linked with mental illness, which should be treated instead of (only) being punished, he strictly objected to the death penalty; and (5) he suggested significantly increasing psychiatry’s influence on decisions regarding the kind and length of imprisonment.
References Arnold, A. (1980). Wilhelm Wundt—Sein philosophisches System. Berlin: Akademie. Aschaffenburg, G. (1929). Der Einflub Kraepelins auf die Kriminalpsychologie und Kriminalpolitik. Archiv für Psychiatrie und Nervenkrankheiten, 87, 87–95. Bayle, A. L. J. (1822). Recherches sur les maladies mentales. Paris. PhD Dissertation. Boring, E. G. (1950). A history of experimental psychology. 2nd edition. New York: Appleton-CenturyCrofts. Danziger, K. (1990). Constructing the subject: Historical origins of psychological research. Cambridge: Cambridge University Press. Engstrom, E. J. (1991). Emil Kraepelin: Psychiatry and public affairs in Wilhelmine Germany. History of Psychiatry, 2, 111–132. Falret, J. (1854). De la folie circulaire. Paris: Academie de Medecine. Griesinger, W. (1845). Die Pathologie und Therapie der psychischen Krankheiten. Stuttgart: Krabbe. Heimann, H. (1988). Aetiologievorstellungen in der Psychiatrie im Wandel der Zeiten. In F. Boecker & W. Weig (Eds.), Aktuelle Kernfragen in der Psychiatrie. Berlin: Springer. Hermle, L. (1986). Die Degenerationslehre in der Psychiatrie. Fortschritte Neurologie und Psychiatrie, 54, 69–79. Hippius, H., Hoff, P., & Muench, U. (1986). Murnau and the History of Psychiatry. In New Results in Depression Research (pp. 1–6). New York: Springer. Hoff, P. (1985). Zum Krankheitsbegriff bei Emil Kraepelin. Nervenarzt, 56, 510–513. Hoff, P. (1988). Nosologische Grundpostulate bei Kraepelin—Versuch einer kritischen Würdigung des Kraepelinschen Spätwerkes. Zeitschrift für Klinische Psychologie, Psychopathologie und Psychotherapie, 36, 328–336. Hoff, P. (1992). Emil Kraepelin and philosophy: The implicit philosophical assumptions of Kraepelinian psychiatry. In M. Spitzer, F. A. Uehlein, M. A. Schwartz, & C. Mundt (Eds.), Phenomenology, Language and Schizophrenia (pp. 115–125). New York: Springer. Hoff, P. (1994). Emil Kraepelin und die Psychiatrie als klinische Wissenschaft. Ein Beitrag zum Selbstverständnis psychiatrischer Forschung. Monographien aus dem Gesamtgebiete der Psychiatrie, Band 73. Berlin: Springer. Hundert, E. M. (1990). Are psychotic illnesses category disorders? In M. Spitzer & B. A. Maher (Eds.), Philosophy and Psychopathology (pp. 59–70). New York: Springer. Hundert, E. M. (1992). The brain’s capacity to form delusions as an evolutionary strategy for survival. In M. Spitzer, F. A. Uehlein, M. A. Schwartz, & C. Mundt (Eds.), Phenomenology, Language and Schizophrenia (pp. 346–354). New York: Springer. Jones, D. A. (1986). History of Criminology—A Philosophical Perspective. New York: Greenwood. Kahlbaum, K. L. (1874). Die Katatonie oder das Spannungsirresein. Berlin: A. Hirschwald. Kempe, G. Th. (1969). Franz von Liszt und die Kriminologie. In Franz von Liszt zum Gedächtnis (pp. 260– 280). Berlin: de Gruyter. Kraepelin, E. (1880). Die Abschaffung des Strafmabes. Ein Vorschlag zur Reform der heutigen Rechtspflege. Stuttgart: Enke. Kraepelin, E. (1885). Lombroso’s L’uomo delinquente. Zeitschrift für Strafrechtspflege, 5, 669–680. Kraepelin, E. (1904a). Zur Frage der geminderten Zurechnungsfähigkeit. Monatsschrift für Kriminalpsychologie und Strafrechtsreform, 1, 477–493. Kraepelin, E. (1904b). Die strafrechtliche Behandlung der geistig Minderwertigen, 27, Deutsche Juristentagung, Innsbruck 1904. Verh. 4, 418–434. Kraepelin, E. (1907). Das Verbrechen als soziale Krankheit. Monatsschrift für Kriminalpsychologie und Strafrechtsreform, 3, 257–279. Kraepelin, E. (1987). Lebenserinnerungen. In H. Hippius, G. Peters, & D. Ploog (Eds.), Memoirs. Berlin: Springer.
EMIL KRAEPELIN AND FORENSIC PSYCHIATRY
353
Liegeois, A. (1991). Hidden philosophy and theology in Morel’s theory of degeneration and nosology. History of Psychiatry, 2, 419–427. Lombroso, C. (1876). L’uomo delinquente in rapporto alla antropologia, alla giurisprudenza ed alle discipline carceria. Milano. Magnan, V. (1891–1893). Psychiatrische Vorlesungen. Deutsch von P J Möbius. Leipzig: Thieme. Magnan, V. (1896). Les dégénérés. Paris. Morel, B. A. (1857). Traite des degenerescences. Paris: Bailliere. Morel, B. A. (1864). De la formation du type dans les varietes degeneres. Paris: Bailliere/Masson. Pauleikhoff, B. (1987). Das Menschenbild im Wandel der Zeit. Ideengeschichte der Psychiatrie und der klinischen Psychologie. Band 3. Hürtgenwald: Pressler. Pick, D. (1989). Faces of Degeneration: A European Disorder 1848–1918. Cambridge: Cambridge University Press. Ranieri, S. (1969). Franz von Liszt und die positive Strafrechtsschule in Italien. In: Franz von Liszt zum Gedächtnis (pp. 156–178). Berlin: de Gruyter. Schneider, Chr. M. (1990). Wilhelm Wundts Völkerpsychologie. Bonn: Bouvier. Titchener, E. B. (1921). Wilhelm Wundt. American Journal of Psychology, 32, 161–178. von Engelhardt, D. (1983). Kriminalität zwischen Krankheit und Abnormität im wissenschaftlichen Denken des 19. Jahrhunderts. In H. J. Kerner, H. Göppinger, & F. Streng (Eds.), Kriminologie—Psychiatrie— Strafrecht. Festschrift für Heinz Leferenz (pp. 261–278). Heidelberg: Müller. Weber, M. M. (1991). Ein Forschungsinstitut für Psychiatrie. Die Entwicklung der Deutschen Forschungsanstalt für Psychiatrie München 1917–1945. Sudhoffs Archiv, 75, 74–89. Wilmanns (1927). Die sogenannte verminderte Zurechnungsfähigkeit als zentrales Problem der Entwürfe zu einem Deutschen Strafgesetzbuch, 30, Vorlesungen: Berlin. Wundt, W. (1880). Grundzüge der physiologischen Psychologie, 4, umgearbeitete Auflage. Leipzig: Engelmann. Wundt, W. (1900–1920). Völkerpsychologie. Eine Untersuchung der Entwicklungsgesetze von Sprache, Mythus und Sitte. 10 Bände. Leipzig: Engelmann.