Classic Text No. 126: ‘Some main features in the history of the paranoid illness forms’,by Aa. Thune Jacobsen (1921)

The author

Aa. Thune Jacobsen (1875–1962) was a prominent figure in Danish psychiatry. After training at the Middelfart Mental Asylum under Frederik Lange, he became psychiatric superintendent at the Risskov Mental Hospital (1921–45), where he was succeeded by Erik Strömgren (Schioldann-Nielsen, 1993).

Jacobsen wanted to emphasize the interesting fact that, in general, psychiatry was far less interested than conventional medicine in the question of how illnesses occur and what causes they have. He attributed this reduced interest to the fact that in psychiatry most known causal facts were just occasional or predisposing.

In regard to Danish psychiatry, however, Jacobsen believed that in Lange he had found a psychiatrist who was strongly interested in the aetiological question. Influenced by Morel (1860), Lange had proposed in his psychiatric textbook (1894; see also 1883) that causes could shed light on the origin, development and form of the psychiatric disorder; and that this approach could be complemented by a study of family inheritability, predispositions, psychological influences, bodily illnesses, and so forth.

The influence of Lange’s views can be seen in Jacobsen’s initial interests in the origin and triggering of the psychoses. However, when researching into the confusional states he soon realized that aetiology alone was too weak a classificatory criterion, and that it needed to be reinforced in each case by a psychological understanding of how the manifold aetiological factors shape the form and future course of the disorder.

Jacobsen’s interest in paranoia was apparently triggered by a lecture by Professor Viggo Christiansen on ‘The position of paranoia in modern psychiatry’, delivered at the 1909 Danish psychiatrists’ meeting in Copenhagen. Christiansen (1910) had suggested that knowledge on paranoia could be obtained by long-term observation of sufferers admitted to mental asylums. Jacobsen carried out a follow-up study of this nature, applied an aetiological-genetic classification and was able to identify a particular form of psychogenic paranoia, which he connected with the work of Wimmer (1918), Wernicke, Freud, Bleuler and Jaspers.

The text offered here as a Classic Text is the Introduction of the book that Jacobsen wrote reporting his study (Thune Jacobsen, 1921). Therein he intimated that he had been influenced in his views by, among others, Wimmer’s 1902 thesis on paranoia. Jacobsen offers a magisterial overview of the paranoia question, as it was unfolding at the time in the German, French and Scandinavian literature, but for some reason he left out the Anglo-American contribution. It is also clear that his ideas were shaped by the work of Kraepelin and Magnan.