Sigmund Freud and Emil Kraepelin: 150 Years Old

It almost makes those who doubt the validity of astrology have second thoughts about it. Freud and Kraepelin, the two great pillars of modern psychiatry, were both born in 1856, only three months and 300 miles apart. But whatever the conjunction of planets, the time and place of their appearance on the medical scene were ideal. For the late 19th century, especially in the German-speaking lands of Europe, was an era of breathtaking advances in medicine, but special challenges in the field of psychiatry.

For so many centuries, medicine had been based on largely useless theorizing, such as the classical Greco-Roman concept of four humors and the vitalism of the natural philosophers. Therapeutic techniques had been hit and miss and often did more harm than good. But 1858 saw the publication of Rudolf Virchow's monumental Cellular Pathology. By the 1870s the germ theory and the concept of specific etiology of transmissible diseases were in the ascendancy. Vaccinations and antitoxins were being developed. The periodic table of the elements had been drawn up, and the new chemistry was increasingly applied to human biology.

In the field of psychiatry, however, developments were slow paced. The neuron would play hide and seek with the microscopists for decades. As the concept of vitalism retreated from the rest of the body, it found a fortress in the brain. Philosophical debates raged around mind-body duality or (alternatively) mind-body parallelism, and the riddle of consciousness and volition.

Sigmund Freud was born in Freiberg, in the Austrian Empire (today Pribor, Czech Republic) on May 6, 1856. Three years later the family moved to Vienna, where years later Sigmund studied medicine. His teacher Theodor Meynert espoused the concept of anatomic localization of mental function and conceived of consciousness as an epiphenomenon of strong cortical stimulation. But Freud was drawn to the model of the English neurologist John Hughlings Jackson of hierarchical dynamic neural functioning, and of powerful cortical activity that could be outside of conscious awareness.

Among Freud's important contributions to neurology was his monograph“ On Aphasia,” published in 1891, which, among other things, highlighted the diagnostic differentiation between hysterical speech impairment and true organic aphasia.

But already Freud was moving away from the physiological and developing his revolutionary psychoanalytic theory. His focus was more on subtle language disruptions as signs of neurotic conflicts caused by unconscious forces: slips of the tongue and lapses of memory in wakefulness, and displacements, condensations, and reversals in the (semiotic) “language” of dreams.

Freud was briefly—but passionately—drawn back to neurology in the mid-1890s, when, at long last, the neuron was established as the basic building block of the nervous system. He feverishly worked on what he called“ A Psychology for Neurologists” (also known as the“ Project”), striving to elucidate the normal and pathological functioning of the mind on a quasi-neurological basis. But soon a despairing Freud abandoned the endeavor.

Freud went on to develop his metapsychological model of the mind, with its conscious and unconscious systems—eventually evolving into a tripartite (ego/id/superego) division. The corresponding psychoanalytic method of treatment for neuroses was the “talking cure,” shedding light on the unconscious. (Although Freud applied some psychoanalytic concepts for elucidating the psychoses, he considered them beyond his therapeutic scope.)

While never abandoning the principle that even the most subtle workings of the Oedipus complex are explicable in neurological terms, Freud stated in 1917, “Psychoanalysis must keep itself free from any hypothesis which is alien to it, whether of an anatomical, chemical, or physiological kind, and must operate entirely with psychological auxiliary ideas.”

Emil Kraepelin was born on February 15, 1856, in Neustrelitz, Prussia, on the Baltic coast. He studied medicine at Leipzig under, among others, Wilhelm Wundt, the “father of psychology,” who pioneered controlled experimental techniques as well as psychopharmacological research.

Kraepelin's focus was primarily on the psychoses. One might have hoped that such gross mental disturbances would be distinctly paralleled by physiological abnormalities. Indeed, for some afflictions—syphilitic paralytic dementia, cretinism, myxedema, as well as various cerebrovascular damage and tumors—something akin to specific etiology was evident. But Kraepelin was thwarted in his search for physiological concomitants of psychoses. The results from his postmortem weighing of various brain parts of people with psychosis were generally disappointing. The toxins he sought in their blood chemistry were similarly elusive.

So Kraepelin, like Freud, was compelled to make his great contribution to psychiatry outside of physiology—namely in nosology.

Prominent alienists, beginning with Philippe Pinel in France in the late 18th century, had made some progress in the classification of the major forms of mental disturbance. But their methodology was faulty. As professor at the universities of Dorpat, Heidelberg, and Munich, Kraepelin conducted meticulous, decades-long studies of thousands of inpatients and outpatients. He distinguished, among other things, those symptoms that are manifest in only some forms of psychoses but appeared to herald long-term deterioration.

In so doing, Kraepelin established a single category, dementia praecox, later to be more appropriately named “schizophrenia.” Kraepelin further recognized the pattern of manic-depressive psychosis and distinguished the various “mixed types” related to the process, such as agitated depression and manic stupor.

Putting his hope for treatment of the various psychoses in pharmacological agents, Kraepelin experimented with a variety of compounds. But effective treatments wouldn't appear until decades after his death.

Though the lives of the two founders of modern psychiatry began in the same year, they ended 13 years apart: Kraepelin died in Munich in 1926, Freud as a refugee in London in 1939.

They shared a strong scientific interest in language and in dreams (albeit for different reasons) and also broad cultural interests in ancient civilizations, theater, and humor.

But the focus of their respective work was so very different—Freud on neuroses and the psychological, Kraepelin on psychoses and the somatic—that they made virtually no reference to one another. They never met or corresponded. To return to our astrology metaphor: The lifelines of Freud and Kraepelin were destined never to cross. ▪