Edward Spitzka's 1883 Textbook: The Psychiatric Nosology That Kraepelin Inherited and Transformed

Edward Spitzka, a prominent New York-based alienist, who spent 3 years in Germany studying psychiatry, published a textbook in 1883-the same year as the first edition of Kraepelin's textbook-that contained detailed descriptions of all the seven psychiatric syndromes that formed the basis of Kraepelin's nosologic synthesis: mania, melancholia, katatonia, secondary deteriorations, hebephrenia, circular insanity, and monomania. A study of this text provides us with a "before" picture-a view of the canvas of psychiatric diagnostic categories-from which Kraepelin worked. Studying what Spitzka's diagnostic categories contain and what they are missing highlights the key steps Kraepelin took in the development of his nosologic synthesis. For example, Spitzka does not describe a commonality in symptoms or outcome in katatonia, hebephrenia, and the move severely ill delusional monomaniacs, nor did he link together mania, melancholia, and circular insanity, but instead comments on wide differences in outcome among these three syndromes.