Abstract
Historians of medicine delight in reconstructing the life course – one might say career – of disease concepts. ‘Biographies of disease’ now appear as formal serial offerings by publishers (see, for example, Healy, 2008), granting them a celebrity status equal to that of famous physicians. To borrow the language of historical sociologist Andrew Abbott (2001: 247–9) regarding the study of individual lives, disease histories are framed by ‘trajectories’ (or ‘master narratives’) and ‘turning points’. Trajectories are the ‘smooth befores and afters … linked by a relatively abrupt “turning point”’(Abbott, 2001: 247). Trajectories are ‘stable regimes’ characterized by their inertial, historicist, causally comprehensible nature. Turning points bracket these deceptively smooth episodes, for they are critical moments when there is a change of trajectory, and they can only be recognized in hindsight. They are ‘causally incomprehensible’ – hence our fascination with them. The life course of an individual – or a disease concept – is the story of a series of chaotic turning points bracketing stable episodes (trajectories). For historians who follow the ‘“who said it first” creed’ (Berrios, Luque and Villagrán, 2003: 128), issues of priority are therefore of paramount importance: collapsing a formerly identified turning point into an expanded trajectory, now bounded by a new focal turning point, might, just might, change the way in which we view the entire life course of a disease concept. Or, as is more often the case, not.
Heinrich Schüle (1840–1916) of the Illenau asylum in Baden, Germany, may now be regarded as the first alienist to use the Latin term dementia praecox. He did so in 1886 in the third edition of his textbook, Klinische Psychiatrie: specielle Pathologie und Therapie der Geisteskrankheiten (Schüle, 1886: 14, 250, 451–2, 477). His use of this term to describe a psychotic disorder predates its use by the Prague psychiatrist Arnold Pick (1851–1924) in 1891, and by Emil Kraepelin (1856–1926) in Heidelberg in 1893 (see: Pick, 1891; Kraepelin, 1893). Whether Schüle was directly influenced by the French alienist Bénédict-Augustin Morel (1809–73), who used the term démence précoce in 1852 and 1860 (see: Berrios, Luque and Villagrán, 2003: 117–18; Dowbiggin, 1996: 388), now becomes the new problem for historians eager to plum the significance of a potential new turning point in the history of psychiatry.
Schüle used the term dementia praecox to refer to an acute disorder in hereditarily predisposed individuals who were – to use an often-repeated paraphrase of his actual words (Schüle, 1886: 452) – ‘wrecked on the cliffs of puberty’ (see Paton, 1905: 373). Some of these young people developed an acute psychotic disorder – dementia praecox – following the ‘crisis’ of puberty, whereas others developed hebephrenia. Dementia praecox and hebephrenia were therefore terms for different conditions, one acute and one chronic. Neither Pick nor Kraepelin used the term dementia praecox to refer to acute conditions.
Will this new fact change the dementia praecox story? Probably not. But perhaps it will stimulate research into the life and work of Heinrich Schüle, a marginal figure in the major histories of psychiatry today, but an asylum physician whose 1886 textbook was widely read and highly regarded by many psychiatrists of that era. Among them was Kraepelin, who prominently listed Schüle’s third edition of Klinische Psychiatrie in the introduction of the 1887 second edition of his own textbook (Kraepelin, 1887: 3) as one of his primary sources for his own work. Thus, Kraepelin was indeed aware of the term dementia praecox at least six years before he introduced it into his own work.