Karl Kleist and the deconstruction of Kraepelin’s diagnostic concept of manic-depressive psychosis

Thomas A. Ban

Deconstruction of Kraepelin’s (1899, 1913) diagnostic concept of “manic depressive psychosis” began in 1911 by Karl Kleist, a former assistant to Wernicke during his short tenure, from 1904 to 1905, as professor of Neurology and Psychiatry in Halle, Germany.

In a paper published, in 1911, in the Zeitschrift fur die Gesamte Neurologie and Psychiatrie, Kleist, challenged Kraepelin’s (1899) diagnostic concept of “manic-depressive insanity”, and argued for the independence of the “manic syndrome” from the “melancholic syndrome“. By using the terms “einpolig mania” that translates into English as “unipolar mania” and the term, “einpolig melancholia”, in reference to these distinct syndromes, Kleist (1911) set the stage for a development that led in the 1940’s to the “unipolar-bipolar dichotomy” of ”mood disorders” (Angst and Grobler 2015; Kleist 1943; Leonhard 1948). Subsequently, in the next three decades, Kleist referred to “unipolar mania” and “unipolar melancholia” as “pure mania” and “pure melancholia”, respectively, and to “bipolar (zweipolig) mania” and “bipolar (zweipolig) melancholia” as “polymorphous mania” and “polymorphous melancholia”.

 It was also in his 1911 paper that Kleist (1911) described several syndromes, in which changes in “motility” were central (Shorter 2005). Included among them was the syndrome that was to become the diagnostic concept of “akinetic motility psychosis” and the syndrome that was to become the diagnostic concept of “hyperkinetic motility psychosis”. Recognition of the affinity of this pair of “motility syndromes” to each other, opened the path for the development of the diagnostic concept of “cycloid psychoses”, in the mid-1920’s (Kleist1925).  

The term “cycloid psychoses” was introduced by Kleist, in 1925, for a group of recurrent psychoses with full remission between episodes, which circled between two “poles”, as “manic-depressive psychosis” but in which the dominant psychopathology was  not “elated” and “melancholic” mood, as in “manic-depressive insanity”, but in another area of mental pathology. He also referred to the same group of psychoses as “marginal psychoses” (Randpsychosen) or “marginal degeneration (constitutional) psychoses” as he perceived them as psychoses which are bordering on “manic-depressive insanity” (Kleist 1928; Teichmann 1990). By the time of the mid-1930’s, he recognized three “cycloid psychoses”: “anxiety-ecstatic delusional psychosis”, “excited-inhibited confusion psychosis” and “hyperkinetic-akinetic motility psychosis” (Funfgeld 1935).

The distinctiveness of the “cycloid psychoses”, “mania”, “melancholia” from each other and from “manic-depressive insanity” received support by the findings of Edda Neele, a student of Kleist. She evaluated all “phasic sicknesses” diagnosed at Kleist’s University Clinic in Frankfurt between 1938 and 1942 and presented the results of her “genetic study”, in 1949, in a monograph with the title Die phasischen Psychosen nach ihrem Erscheinungs und Erbbild (The Phasic Psychoses According to Presentation and Family History).  It was in Neele’s monograph,  in which the “phasic psychoses” were separated for the first time into “pure (unipolar) phasic psychoses”, that included  “melancholia”, “anxious melancholia”, “anxious reference psychosis”, “hypochondriacal depression”, “depressive stupor”, mania”, “ecstatic inspiration psychosis” and “hypochondriacal excitement”, and “polymorphous (bipolar) phasic psychoses” that included “manic-depressive illness of affect”, “hyperkinetic-akinetic motility psychosis”, “excited-stuporous confusion psychosis” and “anxious-ecstatic delusional psychosis” (Angst and Grober 2015;  Shorter 2005; Teichmann 1990). Her classification of “phasic psychoses” was endorsed by Kleist (1953).

 References

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Thomas A. Ban

November 19, 2015