Emil Kraeplin, the Degenerative Theory and its Implications for Psychiatry and Stigma
16th October 2023
Emil Kraeplin (1856-1926) was a prominent German psychiatrist who solidified viewpoints of that time period with a decidedly pessimistic view of the mentally ill. The mentally ill were not considered "normal" and a theory of mental illness known as the "degenerative theory" subscribed to the idea that mental illness was hereditary and degenerative through successive generations.
Kraeplin and his contemporaries drew such a negative view based on their work with a misrepresentative sample of the most-chronically institutionalized mentally ill individuals, but from that sampling drew broader conclusions that stigmatized anyone who fell within the labels that Kraeplin himself was largely responsible for institutionalizing, something that has been perpetuated to today's medical model of psychiatry. Strong advocates of the medical model psychiatry can be referred to as neoKraeplinians. Actually, it is not difficult to see why some hold to the view that part of the philosophical undercurrents of Nazi thoughts on racial superiority and cleansing can be traced to the same source as the roots of the negative medical model of modern psychiatry with its labeling system and stigma.Emil Kraeplin (1856-1926) - German psychiatrist, father of the modern psychiatric labeling system, social Darwinist, and proponent of eugenics, whose thinking is likely to have had a role in influencing Nazi ideals.
"A convinced social-Darwinist, he became a fervent advocate of alcoholic abstinence and actively promoted a policy and research agenda in eugenics and racial hygiene. He was deeply concerned about the impact of urban life on mental health and and was convinced that institutions such as the welfare state and the education system--because they tended to contravene the processes of natural selection--subverted the German people's biological "struggle for survival.""
Authors of the article published in Biological Psychiatry, which can be read on the University of Pittsburgh Department of Psychiatry website, "Degeneration Theory and the Stigma of Schizophrenia", research-based evidence indicates that only one-third to one-quarter of schizophrenics are chronically schizophrenic, that a substantial number recover, and for many, symptoms are mild rather than chronic.
Contrasting the Less Negative and More-Accurate Vulnerability Model
A model that is more accurate and that avoids the trappings of Kraeplinian thinking is referred to as the "vulnerability model" which proposes the schizophrenia is not continuous, but that vulnerability to it is, that schizophrenia can be triggered by "exogenous or endogenous life event stressors." With the absence of these stressors, the patient returns to his "normal" or non-episodic state. With that in mind, with appropriate therapy (or in the view of the AYCNP, self-help through lifestyle changes), recurrences can be avoided. "Once epileptic always epileptic" is not valid, "once schizophrenic always schizophrenic" "once bipolar always bipolar" are invalid assumptions based on the work of what some might consider to be one (or a group of) tacit Nazi instigatives.
Eugenics - the science of improving a human population by controlled breeding to increase the occurrence of desirable heritable characteristics. Developed largely by Francis Galton as a method of improving the human race, it fell into disfavor only after the perversion of its doctrines by the Nazis.
References for Emil Kraeplin, the Degenerative Theory and its Implications for Psychiatry and Stigma
1. Emil Kraepelin. Encyclopedia Britannica. Retrieved January 1, 2014. http://www.britannica.com/EBchecked/topic/323108/Emil-Kraepelin
2. Engstrom, E., PhD., Weber, M., M.D., Burgmair, W., PhD. (2006). Images in Psychiatry - Emil Wilhelm Magnus Georg Kraepelin (1856–1926). Am J Psychiatry 163:10, October 2006. http://ajp.psychiatryonline.org/data/Journals/AJP/3778/06aj1710.PDF
3. Ingram, R. E., Price, J. M. (2010). Vulnerability to Psychopathology: Risk Across the Lifespan. New York: Guilford Press. http://books.google.com/books?id=zwETQphjfqoC&printsec;=frontcover#v=onepage&q;&f;=false
4. Zubin, J. Oppenheimer, G., Neugebauer, R. (1985). Degeneration Theory and the Stigma of Schizophrenia. Biological Psychiatry. 1985;20:1145-1148.
Beyond the Disease Model of Mental Disorders, by Donald Kiesler
The Ethics of Labeling in Mental Health, by Kristie Madsen, Peter Leech
The Strengths Model: A Recovery-Oriented Approach to Mental Health Services, by Charles A. Rapp, Richard J. Goscha