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Lumps and Bumps:Kantian Faculty Psychology, Phrenology, and Twentieth-Century Psychiatric Classification
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Philosophy, Psychiatry, & Psychology 3.1 (1996) 1-14

Abstract: Because other cultures classify mental disorders very differently from ours, it behooves us to inquire into the philosophical and cultural sources of our own guiding nosological categories. This paper is a philosophical exploration into the historical and theoretical bases of the late nineteenth-century, Kraepelinian division between disorders of mood or affect, and schizophrenia, in which our present day nosological categories are rooted. By tracing the early nosologists' divisions into eighteenth-century and Kantian faculty psychology, and following the fate of faculty psychology through the nineteenth century, we discover genealogical elements of our taxonomy likely to affect clinical diagnosis and understanding.
Keywords: phrenology, faculty psychology, affection, passion, cognition, reason, mood disorders, psychiatric classification, Kraepelin

Introduction

Influenced by the great psychiatric classifiers of the past, Western twentieth-century nosological maps reveal a notable division among the severe conditions known as disorders (DSM), or psychoses (ICD). The forms of dysfunction associated with mood or affect are separated from those associated with schizophrenia. We may suppose we understand why this is so. Yet many psychological concepts, we know, are a reflection of culture. And it is not only that other cultures mark aspects of the self, personality, disposition and behavior in terms and categories distinguishable from ours, and adhere to contrary mental health norms. In addition, the very broadest categories and divisions by which different mental disorders are classified are in other cultures and traditions radically different from ours, as a recent survey (1990) by Wig has illustrated. Based upon an analysis of medical classifications in Asian, African and Islamic traditions, Wig concludes of the current division of psychoses separating mood or affective disorder from schizophrenia that "such concepts do not find a recognition in traditional Third World classifications" (195, my emphasis).

Perhaps not a great deal need be made of this. Any one of several possibilities would permit us to avoid the conclusion that our Western division is arbitrary, misleading, or unacceptably culture-bound. Other taxonomies might be wrong, inaccurate, or based on bad science. Or they may be culture-relative: intelligible within the guiding conceptual schemas of the settings which have given rise to them, but "untranslatable." Finally, other taxonomies might be a reflection of cultural variation in epidemiology. Yet whatever they are taken to mean, such findings as Wig's disturb; they seem to invite at least an exploration into the historical and theoretical bases for the late nineteenth-century classification in which our present day division is rooted. They alert us to the possibility of historical contingencies which might mean our taxonomy is less than universally applicable, arbitrary, or worse, reflective of some ideological or normative bias.

That is the impetus for the present paper. We need to trace these divisions to their source in the theories of faculty psychology from the eighteenth century in Europe and America, through whose lens early classifiers such as Kraepelin saw the world. Doing so, we shall discover how the separation of affection from cognition looks to be Eurocentric, as Wig's findings suggest, rather than a natural division, and "modernist," a creation of seventeenth- and eighteenth-century thinking. And we shall see how recognition of this feature of the division was obscured -- on the one hand by its transparent familiarity, and on the other by its complex emergence through and relation to faculty psychology, whose own dubious association with phrenology in the nineteenth century led to faculty psychology's ostensible demise.

Diseases of the Intellect and Diseases of the Passions

In the literature on psychiatric classification, classifiers themselves have come to be classified. There are "splitters" who elaborate the differences between disorders and symptom clusters, and "lumpers," who stress the similarities. (Whether these types -- splitters and lumpers -- reflect styles or fashions of classification linked to a particular era, rather than personal idiosyncracy, is an interesting question, but not one explored here.) Kraepelin was a lumper par excellence, and his lumps are reflected in the broad division between manic-depressive disease and dementia praecox. Earlier divisions and "splittings" were brought together by Kraepelin in two categories of psychosis, one for mental disease primarily affecting mood or affect, another for dysfunction or disease primarily affecting...


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