Editing Dementia praecox (section)

===Time component===
[[File:Karl Ludwig Kahlbaum.JPG|thumb|right|[[Karl Ludwig Kahlbaum]] (1828–1899)]]
Psychiatric [[nosology]] in the nineteenth-century was chaotic and characterised by a conflicting mosaic of contradictory systems.<ref>{{harvnb|Kraam|2008|p=77}}; {{harvnb|Jablensky|1999|p=96}}; {{harvnb|Scharfetter|2001|p=[http://www.sanp.ch/pdf/2001/2001-01/2001-01-058.PDF 34]}}; {{harvnb|Engstrom|2003|p=[https://books.google.com/books?id=C1JYNnBLMqQC&pg=PA27 27]}}</ref> Psychiatric disease categories were based upon short-term and [[cross-sectional]] observations of patients from which were derived the putative characteristic [[medical sign|signs]] and [[symptoms]] of a given disease concept.<ref>{{harvnb|Noll|2007a|p=[https://books.google.com/books?id=jzoJxps189IC&pg=PA145 145]}}; {{harvnb|Hoenig|1995|pp=337–8}}; {{harvnb|Kraam|2009|p=88}}</ref> The dominant psychiatric paradigms which gave a semblance of order to this fragmentary picture were Morelian degeneration theory and the concept of "[[unitary psychosis]]" ({{lang|de|Einheitspsychose}}).<ref>{{harvnb|Noll|2007a|p=[https://books.google.com/books?id=jzoJxps189IC&pg=PA145 145]}}; {{harvnb|Engstrom|2003|p=[https://books.google.com/books?id=C1JYNnBLMqQC&pg=PA27 27]}}</ref> This latter notion, derived from the Belgian psychiatrist [[Joseph Guislain]] (1797–1860), held that the variety of symptoms attributed to mental illness were manifestations of a single underlying disease process.<ref>{{harvnb|Noll|2007a|p=[https://books.google.com/books?id=jzoJxps189IC&pg=PA145 145]}}</ref> While these approaches had a diachronic aspect they lacked a conception of mental illness that encompassed a coherent notion of change over time in terms of the natural course of the illness and based upon an empirical observation of changing symptomatology.{{sfn|Noll|2007a|p=[https://books.google.com/books?id=jzoJxps189IC&pg=PA242 242]}}

In 1863, the [[Danzig]]-based psychiatrist [[Karl Ludwig Kahlbaum]] (1828–1899) published his text on psychiatric nosology {{lang|de|Die Gruppierung der psychischen Krankheiten}} (''The Classification of Psychiatric Diseases'').<ref>{{harvnb|Engstrom|2003|p=[https://books.google.com/books?id=C1JYNnBLMqQC&pg=PA263 263]}}; {{harvnb|Pillmann|Marneros|2003|p=163}}; {{harvnb|Kahlbaum|1863}}</ref> Although with the passage of time this work would prove profoundly influential, when it was published it was almost completely ignored by German academia despite the sophisticated and intelligent disease classification system which it proposed.{{sfn|Kraam|2009|p=87}} In this book Kahlbaum categorized certain typical forms of psychosis ({{lang|la|vesania typica}}) as a single coherent type based upon their shared progressive nature which betrayed, he argued, an ongoing degenerative disease process.<ref>{{harvnb|Noll|2007a|p=[https://books.google.com/books?id=jzoJxps189IC&pg=PA242 242]}}; {{harvnb|Pillmann|Marneros|2003|p=163}}</ref> For Kahlbaum the disease process of {{lang|la|vesania typica}} was distinguished by the passage of the patient through clearly defined disease phases: a melancholic stage; a manic stage; a confusional stage; and finally a demented stage.<ref>{{harvnb|Kraam|2009|p=105}}; {{harvnb|Kahlbaum|1863|p=[https://books.google.com/books?id=zYY_AAAAcAAJ&pg=PA135 135]}}</ref>

In 1866, Kahlbaum became the director of a private psychiatric clinic in [[Görlitz]] ([[Kingdom of Prussia|Prussia]], today [[Saxony]], a small town near [[Dresden]]). He was accompanied by his younger assistant, [[Ewald Hecker]] (1843–1909), and during a ten-year collaboration they conducted a series of [[research]] studies on young psychotic patients that would become a major influence on the development of modern psychiatry.

Together Kahlbaum and Hecker were the first to describe and name such [[syndrome]]s as [[dysthymia]], [[cyclothymia]], [[paranoia]], [[catatonia]], and [[hebephrenia]].{{sfn|Porter|1999|p=512}} Perhaps their most lasting contribution to psychiatry was the introduction of the "clinical method" from medicine to the study of mental diseases, a method which is now known as [[psychopathology]].

When the element of time was added to the concept of [[medical diagnosis|diagnosis]], a diagnosis became more than just a description of a collection of symptoms: diagnosis now also defined by [[prognosis]] (course and outcome). An additional feature of the clinical method was that the characteristic symptoms that define syndromes should be described without any prior assumption of brain pathology (although such links would be made later as scientific knowledge progressed). Karl Kahlbaum made an appeal for the adoption of the clinical method in psychiatry in his 1874 book on catatonia. Without Kahlbaum and Hecker there would be no dementia praecox.{{sfn|Hoenig|1995|pp=337–8}}

Upon his appointment to a full professorship in psychiatry at the University of Dorpat (now [[Tartu]], Estonia) in 1886, Kraepelin gave an inaugural address to the faculty outlining his research programme for the years ahead. Attacking the "brain mythology" of [[Theodor Meynert|Meynert]] and the positions of [[Wilhelm Griesinger|Griesinger]] and [[Bernhard von Gudden|Gudden]], [[Emil Kraepelin|Kraepelin]] advocated that the ideas of Kahlbaum, who was then a marginal and little known figure in psychiatry, should be followed. Therefore, he argued, a research programme into the nature of psychiatric illness should look at a large number of patients over time to discover the course which mental disease could take.{{sfn|Steinberger|Angermeyer|2001|pp=297–327}} It has also been suggested that Kraepelin's decision to accept the Dorpat post was informed by the fact that there he could hope to gain experience with chronic patients and this, it was presumed, would facilitate the longitudinal study of mental illness.{{sfn|Berrios|1996|p=[https://books.google.com/books?id=XSD_ucVR3E8C&pg=PA23 23]}}