Donald F. Klein’s final comment

Thomas A. Ban: The Wernicke – Kleist - Leonhard Tradition with Special Reference to Mania, Melancholia and Manic-Depressive Psychosis
Collated by Olaf Fjetland

            What bothers me is the basis for these numerous nosological distinctions. Much sounds symmetrical a priori. The detection of supposed descriptive classes, after poring over a mass of such data, is weak, too easy to   do and too easy to contradict. But even such efforts are not described, instead there are even weaker confirmatory anecdotes. The pattern of validating studies is that two of the very many nosological distinctions show different patterns of familial disorders. It is not at all clear how these hypothesized familial distinctions (assuming there were hypotheses) follow from the nosological distinctions.

            But  even worse — let’s say every nosological distinction  is proved correct by the most   exacting genetic analyses, how does that help the  clinician, since none have been related  to simple prognosis, not to speak of differential treatment effects, and prognosis covariates?  

            Kraepelin became enormously popular because his data-based system was clinically useful. In an era that lacked beneficial treatments, he made prognosis possible, enabling, right there, prediction of different courses for two apparently similar raving maniacs. This was an enormous benefit to the families as it enabled rational planning. Further, the families were all in despair, but now some had grounds for hope — a wonderful clinical accomplishment.

            There are many scientific reasons why Kraepelin outshines the Wernicke-Kleist-Leonhard tradition that seems dominated by an a priori symmetrical approach divorced from validity criteria — but clinical utility is the crushing distinction. 

November 30, 2017