Janusz Rybakowski: Emil Kraepelin´s dchotomy of "endogenous psychoses" in histoical prespective

Carlos Morra’ reply to Nassir Ghaemi’s comment on his comment

        I certainly agree with you that selecting the best Kraepelin, the best Marx or the best Jaspers depends on the specific need of the observer, and we tend to adapt these author’s point of view according to our present needs.

        But my comment goes a little beyond this point, since Kraepelin’s dichotomy was held more vigorously by his followers than the author.

        We have seen other dichotomies like Neurosis-Psychosis which was accepted by many for years until the last decades of this century when many clinicians finally established that it did not apply to the whole universe. It was also recognized that many neuroses had psychotic features. For example, patients with “social anxiety disorder” may have delusions of reference or self- reference hallucinations; patients with PTSD may have hallucinations.

        Kraepelin was eager to find etiological evidence to abandon his clinical, already identified to be arbitrary, position.

        My main concern is that within the field of schizophrenia we are still using Kraepelinian dichotomy in order to keep all subtypes together in the same group. If some of the subtypes have a different age of onset, clinical course, outcome, would this not be enough to consider them  different disorders?

        Are we going to design more sophisticated classifications like the RDoC and conceptual elaborations in order to keep them together or are we going to follow different lines of thought and use different scales in order to discriminate them?    

January 14, 2021