ABSTRACT
Louis-Victor Marcé, MD, of Paris compiled an extensive monograph published in 1858 that surveyed knowledge of psychiatric disorders of women during and following pregnancy. This work has largely been ignored for 150 years. We summarize here what is known about Marcé's life and work, and include selected passages from his monograph. Marcé provides extensive clinical descriptions of syndromes, with 79 case examples, and summarizes etiological theories and treatments characteristic of his era and place. This work was based on cases that he personally evaluated and on other reported cases, all drawn from broad social and economic backgrounds. Marcé shows an appreciation of epidemiological evidence and a critical approach to then conventional pathophysiological and therapeutic views. His work anticipated modern rediscovery of the high risk of depression in pregnancy and of both acute mood disorders and psychoses, postpartum. This comprehensive summary of clinical knowledge of perinatal psychiatric disorders of women is a landmark early contribution to a field that has only recently emerged as a psychiatric subspecialty.
Subject(s)
Lactation/physiology , Mental Disorders/epidemiology , Puerperal Disorders/epidemiology , Women's Health/history , Female , France , History, 19th Century , Humans , Mental Disorders/psychology , Pregnancy , Puerperal Disorders/psychologyABSTRACT
The year 2006 marked the 150th Birthday of Emil Kraepelin and Sigmund Freud. Kraepelin and Freud were two very different yet very similar men. The comparison between their biographies shows many parallels in their lives and personalities. They were, in their time, the two most influential individuals in psychiatry. They wrote and thought about similar topics in the field yet came to quite different conclusions. Both did not show public respect for each other but wrote about the importance of integrating their respective approaches into the study of the mind/brain problem. Psychiatry today continues to struggle with the integration of the biological and psychodynamic approach.
Subject(s)
Mental Disorders/diagnosis , Mental Disorders/therapy , Psychoanalysis/history , Psychoanalytic Theory , Austria , Germany , History, 19th Century , History, 20th Century , Humans , Psychoanalytic TherapyABSTRACT
BACKGROUND: The syndrome of manic-depressive insanity (MDI), as conceptualized by Emil Kraepelin a century ago, with later refinements, continues to dominate research and clinical practice with mood disorder patients. Current understanding of Kraepelin's views by Anglophones is heavily influenced by the late, highly developed, MDI concept represented in the 1921 partial English translation of the last complete edition of his textbook, the product of gradual development over several decades. METHOD: We reviewed all nine editions and revisions of Kraepelin's Textbook (1883-1926) and other writings by him to document the evolution of his views of MDI, and characterized salient developments within biographical and historical contexts. RESULTS: We found support for the traditional impression that Kraepelin's clinical perception of similarities of various forms of periodic psychiatric disorders marked by fundamental dysregulation of excitation and inhibition of thought and behavior, as well as of mood--as distinct from chronic psychotic illnesses--encouraged his broad, mature concept of MDI. However, our findings indicate a complex evolution of Kraepelin's MDI concept in the 1880s and 1890s, his use of more creative and less empirical clinical methods than traditionally believed, and his considerable personal uncertainty about making clear distinctions among MDI, dementia praecox, intermediate conditions, and paranoid disorders--an uncertainty that persisted to the end of his career in the 1920s. CONCLUSIONS: Kraepelin responded to a compelling international need for diagnostic order in nineteenth-century psychiatry, and effectively promoted his diagnostic proposals with a widely used and influential textbook. Though his methods were less empirical than is usually realized, his legacy includes analysis of large clinical samples to describe psychopathology and illness-course, along with efforts to define psychobiologically coherent and clinically differentiable entities, as steps toward defining psychiatric syndromes. Modern international "neo-Kraepelinian" enthusiasm for descriptive, criterion-based diagnosis should be tempered by Kraepelin's own appreciation of the tentative and uncertain nature of psychiatric nosology, particularly in classifying illnesses with both affective and psychotic features.
