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Friday, August 16, 2024

John Forbes Nash Jr.

From Wikipedia, the free encyclopedia
John Forbes Nash Jr.
Nash in the 2000s
BornJune 13, 1928
DiedMay 23, 2015 (aged 86)
Education
Known for
Spouses
Awards
Scientific career
Fields
Institutions
ThesisNon-Cooperative Games (1950)
Doctoral advisorAlbert W. Tucker

John Forbes Nash, Jr. (June 13, 1928 – May 23, 2015), known and published as John Nash, was an American mathematician who made fundamental contributions to game theory, real algebraic geometry, differential geometry, and partial differential equations. Nash and fellow game theorists John Harsanyi and Reinhard Selten were awarded the 1994 Nobel Prize in Economics. In 2015, he and Louis Nirenberg were awarded the Abel Prize for their contributions to the field of partial differential equations.

As a graduate student in the Princeton University Department of Mathematics, Nash introduced a number of concepts (including Nash equilibrium and the Nash bargaining solution) which are now considered central to game theory and its applications in various sciences. In the 1950s, Nash discovered and proved the Nash embedding theorems by solving a system of nonlinear partial differential equations arising in Riemannian geometry. This work, also introducing a preliminary form of the Nash–Moser theorem, was later recognized by the American Mathematical Society with the Leroy P. Steele Prize for Seminal Contribution to Research. Ennio De Giorgi and Nash found, with separate methods, a body of results paving the way for a systematic understanding of elliptic and parabolic partial differential equations. Their De Giorgi–Nash theorem on the smoothness of solutions of such equations resolved Hilbert's nineteenth problem on regularity in the calculus of variations, which had been a well-known open problem for almost sixty years.

In 1959, Nash began showing clear signs of mental illness, and spent several years at psychiatric hospitals being treated for schizophrenia. After 1970, his condition slowly improved, allowing him to return to academic work by the mid-1980s.[3]

Nash's life was the subject of Sylvia Nasar's 1998 biographical book A Beautiful Mind, and his struggles with his illness and his recovery became the basis for a film of the same name directed by Ron Howard, in which Nash was portrayed by Russell Crowe.[4][5][6]

Early life and education

John Forbes Nash Jr. was born on June 13, 1928, in Bluefield, West Virginia. His father and namesake, John Forbes Nash Sr., was an electrical engineer for the Appalachian Electric Power Company. His mother, Margaret Virginia (née Martin) Nash, had been a schoolteacher before she was married. He was baptized in the Episcopal Church. He had a younger sister, Martha (born November 16, 1930).

Nash attended kindergarten and public school, and he learned from books provided by his parents and grandparents. Nash's parents pursued opportunities to supplement their son's education, and arranged for him to take advanced mathematics courses at nearby Bluefield College (now Bluefield University) during his final year of high school. He attended Carnegie Institute of Technology (which later became Carnegie Mellon University) through a full benefit of the George Westinghouse Scholarship, initially majoring in chemical engineering. He switched to a chemistry major and eventually, at the advice of his teacher John Lighton Synge, to mathematics. After graduating in 1948, with both a B.S. and M.S. in mathematics, Nash accepted a fellowship to Princeton University, where he pursued further graduate studies in mathematics and sciences.

Nash's adviser and former Carnegie professor Richard Duffin wrote a letter of recommendation for Nash's entrance to Princeton stating, "He is a mathematical genius." Nash was also accepted at Harvard University. However, the chairman of the mathematics department at Princeton, Solomon Lefschetz, offered him the John S. Kennedy fellowship, convincing Nash that Princeton valued him more. Further, he considered Princeton more favorably because of its proximity to his family in Bluefield. At Princeton, he began work on his equilibrium theory, later known as the Nash equilibrium.

Research contributions

Nash in November 2006 at a game theory conference in Cologne, Germany

Nash did not publish extensively, although many of his papers are considered landmarks in their fields.[13] As a graduate student at Princeton, he made foundational contributions to game theory and real algebraic geometry. As a postdoctoral fellow at MIT, Nash turned to differential geometry. Although the results of Nash's work on differential geometry are phrased in a geometrical language, the work is almost entirely to do with the mathematical analysis of partial differential equations. After proving his two isometric embedding theorems, Nash turned to research dealing directly with partial differential equations, where he discovered and proved the De Giorgi–Nash theorem, thereby resolving one form of Hilbert's nineteenth problem.

In 2011, the National Security Agency declassified letters written by Nash in the 1950s, in which he had proposed a new encryption–decryption machine. The letters show that Nash had anticipated many concepts of modern cryptography, which are based on computational hardness.

Game theory

Nash earned a PhD in 1950 with a 28-page dissertation on non-cooperative games. The thesis, written under the supervision of doctoral advisor Albert W. Tucker, contained the definition and properties of the Nash equilibrium, a crucial concept in non-cooperative games. A version of his thesis was published a year later in the Annals of Mathematics. In the early 1950s, Nash carried out research on a number of related concepts in game theory, including the theory of cooperative games. For his work, Nash was one of the recipients of the Nobel Memorial Prize in Economic Sciences in 1994.

Real algebraic geometry

In 1949, while still a graduate student, Nash found a new result in the mathematical field of real algebraic geometry. He announced his theorem in a contributed paper at the International Congress of Mathematicians in 1950, although he had not yet worked out the details of its proof. Nash's theorem was finalized by October 1951, when Nash submitted his work to the Annals of Mathematics. It had been well-known since the 1930s that every closed smooth manifold is diffeomorphic to the zero set of some collection of smooth functions on Euclidean space. In his work, Nash proved that those smooth functions can be taken to be polynomials. This was widely regarded as a surprising result, since the class of smooth functions and smooth manifolds is usually far more flexible than the class of polynomials. Nash's proof introduced the concepts now known as Nash function and Nash manifold, which have since been widely studied in real algebraic geometry. Nash's theorem itself was famously applied by Michael Artin and Barry Mazur to the study of dynamical systems, by combining Nash's polynomial approximation together with Bézout's theorem.

Differential geometry

During his postdoctoral position at MIT, Nash was eager to find high-profile mathematical problems to study. From Warren Ambrose, a differential geometer, he learned about the conjecture that any Riemannian manifold is isometric to a submanifold of Euclidean space. Nash's results proving the conjecture are now known as the Nash embedding theorems, the second of which Mikhael Gromov has called "one of the main achievements of mathematics of the twentieth century".

Nash's first embedding theorem was found in 1953. He found that any Riemannian manifold can be isometrically embedded in a Euclidean space by a continuously differentiable mapping. Nash's construction allows the codimension of the embedding to be very small, with the effect that in many cases it is logically impossible that a highly-differentiable isometric embedding exists. (Based on Nash's techniques, Nicolaas Kuiper soon found even smaller codimensions, with the improved result often known as the Nash–Kuiper theorem.) As such, Nash's embeddings are limited to the setting of low differentiability. For this reason, Nash's result is somewhat outside the mainstream in the field of differential geometry, where high differentiability is significant in much of the usual analysis.

However, the logic of Nash's work has been found to be useful in many other contexts in mathematical analysis. Starting with work of Camillo De Lellis and László Székelyhidi, the ideas of Nash's proof were applied for various constructions of turbulent solutions of the Euler equations in fluid mechanics. In the 1970s, Mikhael Gromov developed Nash's ideas into the general framework of convex integration, which has been (among other uses) applied by Stefan Müller and Vladimír Šverák to construct counterexamples to generalized forms of Hilbert's nineteenth problem in the calculus of variations.

Nash found the construction of smoothly differentiable isometric embeddings to be unexpectedly difficult. However, after around a year and a half of intensive work, his efforts succeeded, thereby proving the second Nash embedding theorem. The ideas involved in proving this second theorem are largely separate from those used in proving the first. The fundamental aspect of the proof is an implicit function theorem for isometric embeddings. The usual formulations of the implicit function theorem are inapplicable, for technical reasons related to the loss of regularity phenomena. Nash's resolution of this issue, given by deforming an isometric embedding by an ordinary differential equation along which extra regularity is continually injected, is regarded as a fundamentally novel technique in mathematical analysis. Nash's paper was awarded the Leroy P. Steele Prize for Seminal Contribution to Research in 1999, where his "most original idea" in the resolution of the loss of regularity issue was cited as "one of the great achievements in mathematical analysis in this century". According to Gromov:

You must be a novice in analysis or a genius like Nash to believe anything like that can be ever true and/or to have a single nontrivial application.

Due to Jürgen Moser's extension of Nash's ideas for application to other problems (notably in celestial mechanics), the resulting implicit function theorem is known as the Nash–Moser theorem. It has been extended and generalized by a number of other authors, among them Gromov, Richard Hamilton, Lars Hörmander, Jacob Schwartz, and Eduard Zehnder. Nash himself analyzed the problem in the context of analytic functions. Schwartz later commented that Nash's ideas were "not just novel, but very mysterious," and that it was very hard to "get to the bottom of it." According to Gromov:

Nash was solving classical mathematical problems, difficult problems, something that nobody else was able to do, not even to imagine how to do it. ...  what Nash discovered in the course of his constructions of isometric embeddings is far from 'classical' – it is something that brings about a dramatic alteration of our understanding of the basic logic of analysis and differential geometry. Judging from the classical perspective, what Nash has achieved in his papers is as impossible as the story of his life ... [H]is work on isometric immersions ... opened a new world of mathematics that stretches in front of our eyes in yet unknown directions and still waits to be explored.

Partial differential equations

While spending time at the Courant Institute in New York City, Louis Nirenberg informed Nash of a well-known conjecture in the field of elliptic partial differential equations. In 1938, Charles Morrey had proved a fundamental elliptic regularity result for functions of two independent variables, but analogous results for functions of more than two variables had proved elusive. After extensive discussions with Nirenberg and Lars Hörmander, Nash was able to extend Morrey's results, not only to functions of more than two variables, but also to the context of parabolic partial differential equations. In his work, as in Morrey's, uniform control over the continuity of the solutions to such equations is achieved, without assuming any level of differentiability on the coefficients of the equation. The Nash inequality was a particular result found in the course of his work (the proof of which Nash attributed to Elias Stein), which has been found useful in other contexts.

Soon after, Nash learned from Paul Garabedian, recently returned from Italy, that the then-unknown Ennio De Giorgi had found nearly identical results for elliptic partial differential equations. De Giorgi and Nash's methods had little to do with one another, although Nash's were somewhat more powerful in applying to both elliptic and parabolic equations. A few years later, inspired by De Giorgi's method, Jürgen Moser found a different approach to the same results, and the resulting body of work is now known as the De Giorgi–Nash theorem or the De Giorgi–Nash–Moser theory (which is distinct from the Nash–Moser theorem). De Giorgi and Moser's methods became particularly influential over the next several years, through their developments in the works of Olga Ladyzhenskaya, James Serrin, and Neil Trudinger, among others. Their work, based primarily on the judicious choice of test functions in the weak formulation of partial differential equations, is in strong contrast to Nash's work, which is based on analysis of the heat kernel. Nash's approach to the De Giorgi–Nash theory was later revisited by Eugene Fabes and Daniel Stroock, initiating the re-derivation and extension of the results originally obtained from De Giorgi and Moser's techniques.

From the fact that minimizers to many functionals in the calculus of variations solve elliptic partial differential equations, Hilbert's nineteenth problem (on the smoothness of these minimizers), conjectured almost sixty years prior, was directly amenable to the De Giorgi–Nash theory. Nash received instant recognition for his work, with Peter Lax describing it as a "stroke of genius". Nash would later speculate that had it not been for De Giorgi's simultaneous discovery, he would have been a recipient of the prestigious Fields Medal in 1958. Although the medal committee's reasoning is not fully known, and was not purely based on questions of mathematical merit, archival research has shown that Nash placed third in the committee's vote for the medal, after the two mathematicians (Klaus Roth and René Thom) who were awarded the medal that year.

Mental illness

Although Nash's mental illness first began to manifest in the form of paranoia, his wife later described his behavior as erratic. Nash thought that all men who wore red ties were part of a communist conspiracy against him. He mailed letters to embassies in Washington, D.C., declaring that they were establishing a government. Nash's psychological issues crossed into his professional life when he gave an American Mathematical Society lecture at Columbia University in early 1959. Originally intended to present proof of the Riemann hypothesis, the lecture was incomprehensible. Colleagues in the audience immediately realized that something was wrong.

In April 1959, Nash was admitted to McLean Hospital for one month. Based on his paranoid, persecutory delusions, hallucinations, and increasing asociality, he was diagnosed with schizophrenia. In 1961, Nash was admitted to the New Jersey State Hospital at Trenton. Over the next nine years, he spent intervals of time in psychiatric hospitals, where he received both antipsychotic medications and insulin shock therapy.

Although he sometimes took prescribed medication, Nash later wrote that he did so only under pressure. According to Nash, the film A Beautiful Mind inaccurately implied he was taking atypical antipsychotics. He attributed the depiction to the screenwriter who was worried about the film encouraging people with mental illness to stop taking their medication.

Nash did not take any medication after 1970, nor was he committed to a hospital ever again. Nash recovered gradually. Encouraged by his then former wife, de Lardé, Nash lived at home and spent his time in the Princeton mathematics department where his eccentricities were accepted even when his mental condition was poor. De Lardé credits his recovery to maintaining "a quiet life" with social support.

Nash dated the start of what he termed "mental disturbances" to the early months of 1959, when his wife was pregnant. He described a process of change "from scientific rationality of thinking into the delusional thinking characteristic of persons who are psychiatrically diagnosed as 'schizophrenic' or 'paranoid schizophrenic'". For Nash, this included seeing himself as a messenger or having a special function of some kind, of having supporters and opponents and hidden schemers, along with a feeling of being persecuted and searching for signs representing divine revelation. During his psychotic phase, Nash also referred to himself in the third person as "Johann von Nassau". Nash suggested his delusional thinking was related to his unhappiness, his desire to be recognized, and his characteristic way of thinking, saying, "I wouldn't have had good scientific ideas if I had thought more normally." He also said, "If I felt completely pressureless I don't think I would have gone in this pattern".

Nash reported that he started hearing voices in 1964, then later engaged in a process of consciously rejecting them. He only renounced his "dream-like delusional hypotheses" after a prolonged period of involuntary commitment in mental hospitals—"enforced rationality". Upon doing so, he was temporarily able to return to productive work as a mathematician. By the late 1960s, he relapsed. Eventually, he "intellectually rejected" his "delusionally influenced" and "politically oriented" thinking as a waste of effort. In 1995, he said that he did not realize his full potential due to nearly 30 years of mental illness.

Nash wrote in 1994:

I spent times of the order of five to eight months in hospitals in New Jersey, always on an involuntary basis and always attempting a legal argument for release. And it did happen that when I had been long enough hospitalized that I would finally renounce my delusional hypotheses and revert to thinking of myself as a human of more conventional circumstances and return to mathematical research. In these interludes of, as it were, enforced rationality, I did succeed in doing some respectable mathematical research. Thus there came about the research for "Le problème de Cauchy pour les équations différentielles d'un fluide général"; the idea that Prof. Heisuke Hironaka called "the Nash blowing-up transformation"; and those of "Arc Structure of Singularities" and "Analyticity of Solutions of Implicit Function Problems with Analytic Data".

But after my return to the dream-like delusional hypotheses in the later 60s I became a person of delusionally influenced thinking but of relatively moderate behavior and thus tended to avoid hospitalization and the direct attention of psychiatrists.

Thus further time passed. Then gradually I began to intellectually reject some of the delusionally influenced lines of thinking which had been characteristic of my orientation. This began, most recognizably, with the rejection of politically oriented thinking as essentially a hopeless waste of intellectual effort. So at the present time I seem to be thinking rationally again in the style that is characteristic of scientists.

Recognition and later career

Nash pictured in 2011

In 1978, Nash was awarded the John von Neumann Theory Prize for his discovery of non-cooperative equilibria, now called Nash Equilibria. He won the Leroy P. Steele Prize in 1999.

In 1994, he received the Nobel Memorial Prize in Economic Sciences (along with John Harsanyi and Reinhard Selten) for his game theory work as a Princeton graduate student. In the late 1980s, Nash had begun to use email to gradually link with working mathematicians who realized that he was the John Nash and that his new work had value. They formed part of the nucleus of a group that contacted the Bank of Sweden's Nobel award committee and were able to vouch for Nash's mental health and ability to receive the award.

Nash's later work involved ventures in advanced game theory, including partial agency, which show that, as in his early career, he preferred to select his own path and problems. Between 1945 and 1996, he published 23 scientific papers.

Nash has suggested hypotheses on mental illness. He has compared not thinking in an acceptable manner, or being "insane" and not fitting into a usual social function, to being "on strike" from an economic point of view. He advanced views in evolutionary psychology about the potential benefits of apparently nonstandard behaviors or roles.

Nash criticized Keynesian ideas of monetary economics which allowed for a central bank to implement monetary policies. He proposed a standard of "Ideal Money" pegged to an "industrial consumption price index" which was more stable than "bad money." He noted that his thinking on money and the function of monetary authority paralleled that of economist Friedrich Hayek.

Nash received an honorary degree, Doctor of Science and Technology, from Carnegie Mellon University in 1999, an honorary degree in economics from the University of Naples Federico II in 2003, an honorary doctorate in economics from the University of Antwerp in 2007, an honorary doctorate of science from the City University of Hong Kong in 2011, and was keynote speaker at a conference on game theory. Nash also received honorary doctorates from two West Virginia colleges: the University of Charleston in 2003 and West Virginia University Tech in 2006. He was a prolific guest speaker at a number of events, such as the Warwick Economics Summit in 2005, at the University of Warwick.

Nash was elected to the American Philosophical Society in 2006 and became a fellow of the American Mathematical Society in 2012.

On May 19, 2015, a few days before his death, Nash, along with Louis Nirenberg, was awarded the 2015 Abel Prize by King Harald V of Norway at a ceremony in Oslo.

Personal life

In 1951, the Massachusetts Institute of Technology (MIT) hired Nash as a C. L. E. Moore instructor in the mathematics faculty. About a year later, Nash began a relationship with Eleanor Stier, a nurse he met while admitted as a patient. They had a son, John David Stier, but Nash left Stier when she told him of her pregnancy. The film based on Nash's life, A Beautiful Mind, was criticized during the run-up to the 2002 Oscars for omitting this aspect of his life. He was said to have abandoned her based on her social status, which he thought to have been beneath his.

In Santa Monica, California, in 1954, while in his twenties, Nash was arrested for indecent exposure in a sting operation targeting gay men. Although the charges were dropped, he was stripped of his top-secret security clearance and fired from RAND Corporation, where he had worked as a consultant.

Not long after breaking up with Stier, Nash met Alicia Lardé Lopez-Harrison, a naturalized U.S. citizen from El Salvador. Lardé graduated from MIT, having majored in physics. They married in February 1957. Although Nash was an atheist, the ceremony was performed in an Episcopal church. In 1958, Nash was appointed to a tenured position at MIT, and his first signs of mental illness soon became evident. He resigned his position at MIT in the spring of 1959. His son, John Charles Martin Nash, was born a few months later. The child was not named for a year because Alicia felt that Nash should have a say in choosing the name. Due to the stress of dealing with his illness, Nash and Lardé divorced in 1963. After his final hospital discharge in 1970, Nash lived in Lardé's house as a boarder. This stability seemed to help him, and he learned how to consciously discard his paranoid delusions. Princeton allowed him to audit classes. He continued to work on mathematics and was eventually allowed to teach again. In the 1990s, Lardé and Nash resumed their relationship, remarrying in 2001. John Charles Martin Nash earned a PhD in mathematics from Rutgers University and was diagnosed with schizophrenia as an adult.

Death

On May 23, 2015, Nash and his wife died in a car accident on the New Jersey Turnpike in Monroe Township, New Jersey while returning home from receiving the Abel Prize in Norway. The driver of the taxicab they were riding in from Newark Airport lost control of the cab and struck a guardrail. Both passengers were ejected and killed. At the time of his death, Nash was a longtime resident of New Jersey. He was survived by two sons, John Charles Martin Nash, who lived with his parents at the time of their death, and elder child John Stier.

Following his death, obituaries appeared in scientific and popular media throughout the world. In addition to their obituary for Nash, The New York Times published an article containing quotes from Nash that had been assembled from media and other published sources. The quotes consisted of Nash's reflections on his life and achievements.

Legacy

At Princeton in the 1970s, Nash became known as "The Phantom of Fine Hall" (Princeton's mathematics center), a shadowy figure who would scribble arcane equations on blackboards in the middle of the night.

He is referred to in a novel set at Princeton, The Mind-Body Problem, 1983, by Rebecca Goldstein.

Sylvia Nasar's biography of Nash, A Beautiful Mind, was published in 1998. A film by the same name was released in 2001, directed by Ron Howard with Russell Crowe playing Nash; it won four Academy Awards, including Best Picture. For his performance as Nash, Crowe won the Golden Globe Award for Best Actor – Motion Picture Drama at the 59th Golden Globe Awards and the BAFTA Award for Best Actor at the 55th British Academy Film Awards. Crowe was nominated for the Academy Award for Best Actor at the 74th Academy Awards; Denzel Washington won for his performance in Training Day.

Awards

Daniel Paul Schreber

 

    From Wikipedia, the free encyclopedia
     
    Daniel Paul Schreber
    Black and white photograph of Schreber
    Born25 July 1842
    Leipzig, Saxony, Germany
    Died14 April 1911 (aged 68)
    Leipzig, Saxony, Germany
    Education
    OccupationJudge
    Known forPsychosis
    Notable workMemoirs of My Nervous Illness
    Parent

    Daniel Paul Schreber (German: [ˈʃʀeːbɐ]; 25 July 1842 – 14 April 1911) was a German judge who was famous for his personal account of his own experience with schizophrenia. Schreber experienced three distinct periods of acute mental illness. The first of these, in 1884-1885 was what was then diagnosed as dementia praecox (later known as paranoid schizophrenia or schizophrenia, paranoid type). He described his second mental illness, from 1893 to 1902, making also a brief reference to the first disorder from 1884 to 1885, in his book Memoirs of My Nervous Illness (German: Denkwürdigkeiten eines Nervenkranken). The Memoirs became an influential book in the history of psychiatry and psychoanalysis because of its interpretation by Sigmund Freud. There is no personal account of his third disorder, in 1907–1911, but some details about it can be found in the Hospital Chart (in the Appendix to Lothane's book). During his second illness he was treated by Paul Flechsig (Leipzig University Clinic), Pierson (Lindenhof), and Guido Weber (Royal Public Asylum, Sonnenstein).[

    Early life, education, and career

    Schreber was born on 25 July 1842 in Leipzig, Germany, the second oldest of five children of physician Daniel Gottlieb Moritz Schreber (1808-1861) and Louise Henrietta Pauline Haase (1815-1907). His paternal great-grandfather was Daniel Gottfried Schreber. Throughout his life, his family suffered from various mental illnesses: his father experienced lifelong depression and his older brother committed suicide in 1877.

    Schreber graduated from St. Thomas School in 1860, began work as a judge for the Ministry of Justice in 1867, and received a doctorate in jurisprudence from University of Leipzig in 1869. He married Ottilie Sabine Behr (1857-1912) in 1878.

    Schizophrenia

    Timeline

    In 1884, Schreber ran for Reichstag and lost. This had a negative effect on his mental health, causing him to enter an asylum for six months. He was treated by psychiatrist Paul Flechsig and left "completely recovered", returning to work in 1886. In October 1893, Schreber became presiding judge of an Oberlandesgericht court and his wife had a stillbirth. He shortly readmitted himself to Fleschsig's clinic seeking treatment for insomnia. His condition worsened in the following years and he was eventually transferred to Sonnenstein Castle. By 1899 he entered remission and was deemed "capable of meeting the demands of everyday life", though still confident in his schizophrenic delusions. He wrote his memoir a year later. Schreber took legal action to be released and won in 1902, but was re-institutionalised in 1907 after his mother died and his wife had a stroke. Schreber died on 14 April 1911 in the Leipzig-Dosen asylum.

    Experiences

    Schreber woke up one morning with the thought that it would be pleasant to "succumb" to sexual intercourse as a woman. He was alarmed and felt that this thought had come from somewhere else, not from himself. He even hypothesized that the thought had come from a doctor who had experimented with hypnosis on him; he thought that the doctor had telepathically invaded his mind. He believed his primary psychiatrist, Paul Flechsig, had contact with him using a "nerve-language" of which Schreber said humans are unaware. He believed that hundreds of people's souls took special interest in him, and contacted his nerves by using "divine rays", telling him special information, or requesting things of him. During one of his stays at the Sonnenstein asylum, he concluded that there are "fleeting-improvised-men" in the world, which he believed were divinely fabricated men, as miracles to provide Schreber with "play-with-humans" in light of a depopulation of the world.

    As his psychosis progressed, he believed that God was turning him into a woman, sending rays down to enact 'miracles' upon him, including little men to torture him. Schreber was released from psychiatric hospitals around 1902, shortly before the publication of his book.

    Worldview

    The fundamental unit of Schreber's ruminations were what he called "nerves", which were said to compose both the human soul and the nature of God in relation to humanity. Each human soul was composed of nerves that derived from God, whose own nerves were then the ultimate source of human existence. Schreber's thought that God's nerves and those of humanity existed parallel to one another except when the "Order of the World" was violated which constituted the fundamental premise of Schreber's memoirs, in which the two universes experienced dangerous "nerve-contact" with each other. For Schreber, this was focused upon his personal and institutional relationship with Flechsig, who became a rebellious "nerve specialist" by virtue of his psychiatric power in contrast to the "Omnipotence" of God.

    The peculiar universe of Schreber's was mediated by the activity of rays, which could assume a "pure" and "impure" relation; these rays could be controlled by Flechsig or emanated strictly from God, who sought to influence Schreber and his reality by "divine miracles". The rays had the capacity for independent activity, though they were distinguished from souls and nerves (generally identical) which emanated from other human beings deceased or living. Within Schreber's cosmology the universe as an observable reality, and the Sun especially, was a partially independent realm which God merely communicated through, using rays and miracles to influence at times when the "Order of the World" needed to be adjusted. Strictly speaking, God only initiated nerve-contact with human beings through dreams or inspired states (in poetry, etc.), or when humans had become corpses and returned to the "forecourts of Heaven" after purification to rejoin the 'nerve soul' of God. However, the entire crisis which Schreber describes in his book is the dangerous combination between humanity and God within the mind of Schreber.

    Schreber's ruminations can be schematized in this way:

    • God - Upper and lower (Ormuzd and Ahriman respectively, derived from Persian theology)
    • The "forecourts of Heaven" - The "states of Blessedness" where deceased humans' souls reside after a process of "purification" (These are called the "anterior realms of God" in contradistinction to the "posterior" realms which consist of the upper and lower Gods)
    • The Universe - Separated from the transcendental sphere of God providing the human/material world and yet threatening God's invested existence within it; celestial bodies allow the means for God's life/light to interact with His creations
    • Divine rays - Semi-sentient entities (which are the cosmic fuel of God's Omnipotence, and influence Schreber and the world but can be manipulated by Flechsig)
    • Nerves/Souls - The spiritual bodies of humans which are active whether the living person is alive or dead, and go through various states of purification in order to return to God's nerves in a "state of Blessedness"

    There is no Hell in Schreber's cosmology.

    Interpretations

    Freud

    Although Sigmund Freud never interviewed Schreber himself, he read his Memoirs and drew his own conclusions from it in an essay entitled "Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides)" (1911). Freud thought that Schreber's disturbances resulted from repressed homosexual desires, which in infancy were oriented at his father and brother. Repressed inner drives were projected onto the outside world and led to intense hallucinations which were first centred on his physician Flechsig (projection of his feelings towards his brother), and then around God (who represented Schreber's father, Daniel Gottlob Moritz Schreber). During the first phase of his illness Schreber was certain that Flechsig persecuted him and made direct attempts to murder his soul and change him into a woman (he had what Freud thought to be emasculation hallucinations, which were in fact, according to Schreber's words an "unmanning" (Entmannung) experience. In the next period of his ailment he was convinced that God and the order of things demanded of him that he must be turned into a woman so that he could be the sole object of sexual desire of God. Consideration of the Schreber case led Freud to revise received classification of mental disturbances. He argued that the difference between paranoia and dementia praecox is not at all clear, since symptoms of both ailments may be combined in any proportion, as in Schreber's case. Therefore, Freud concluded, it may be necessary to introduce a new diagnostic notion: paranoid dementia, which does justice to polymorphous mental disturbances such as those exhibited by the judge.

    Criticism

    Freud's interpretation has been contested by a number of subsequent theorists, most notably Gilles Deleuze and Félix Guattari in their work Anti-Oedipus and elsewhere. Their reading of Schreber's Memoirs is a part of their wider criticism of familial orientation of psychoanalysis and it foregrounds the political and racial elements of the text; they see Schreber's written experience of reality abnormal only in its honesty about the experience of power in late capitalism. Elias Canetti also devoted the closing chapters of his theoretical magnum opus Crowds and Power to a reading of Schreber. Finally, Jacques Lacan's Seminar on the Psychoses and one of his écrits "On a Question Prior to Any Possible Treatment of Psychosis" are predominantly concerned with reading and evaluating Schreber's text over-against Freud's original and originating interpretation.

    Schatzman

    In 1974, Morton Schatzman published Soul Murder, in which he gave his own interpretation of Schreber's psychosis. Schatzman's interpretation was based on W. G. Niederland's research from the 1950s. (Niederland had previously worked with survivors of Nazi concentration camps.) Schatzman had found child-rearing pamphlets written by Moritz Schreber, Daniel Schreber's father, which stressed the necessity of taming the rebellious savage beast in the child and turning him into a productive citizen. Many of the techniques recommended by Moritz Schreber were mirrored in Daniel Schreber's psychotic experiences. For example, one of the "miracles" described by Daniel Schreber was that of chest compression, of tightening and tightening. This can be seen as analogous to one of Moritz Schreber's techniques of using an elaborate contraption that confined the child's body, forcing him to have a "correct" posture at the dinner table. Similarly, the "freezing miracle" might mirror Moritz Schreber's recommendation of placing the infant in a bath of ice cubes beginning at age three months. Daniel Paul Schreber's older brother, Daniel Gustav Schreber, committed suicide in his thirties. In his 1989 book Schreber: Father and Son, Han Israëls argued against the interpretations of Niederland and Schatzman, claiming that Schreber's father had been unfairly criticized in the literature.

    Lothane

    Henry Zvi Lothane argued against the interpretations of Niederland and Schatzman in his 1992 book, In Defense of Schreber: Soul Murder and Psychiatry. Lothane's Schreber research included the study of archival records concerning the relationship between Schreber and the other significant people in his life, including his wife and his doctors. On Lothane's account, the existing literature on Schreber as a rule (1) leaves substantial gaps in the historical records, which careful archival research could in some measure fill, (2) leaves out psychoanalytically significant relationships, such as that between Schreber and his wife, and (3) overstates the purportedly sadistic elements in Schreber's father's child-rearing techniques. Lothane's interpretation of Schreber also differs from previous texts in that he considers Schreber a worthwhile thinker.

  • Schreber's Memoirs are the starting point and main topic of the 1972 radio play Schreber's Nervous Illness by British playwright Caryl Churchill.
  • Roberto Calasso's first book, and only novel, L'impuro folle (1974), is about Schreber.
  • A character of the same name appears in the 1988 book Empire of the Senseless by Kathy Acker.
  • A character of the same name appears in the 1998 film Dark City, played by Kiefer Sutherland.
  • In the 2006 film Memoirs of My Nervous Illness, based on Schreber's 1903 journal of the same name, Schreber is portrayed by Jefferson Mays.
  • The 2011 docudrama film, Shock Head Soul follows Schreber's demise and later life.
  • Schreber is the first person narrator of Swedish writer Fabian Kastner's novel Lekmannen (The Layman, 2013).
  • In Jenny Davidson's The Magic Circle: A Novel (2013), Lucy uses Memoirs of My Nervous Illness as a text for the seminar she is teaching on "Madness and Literature."
  • The song "Dementia Praecox" from the 2014 album White Deer Park by Papa vs Pretty is about Daniel Paul Schreber.
  • Schreber is the subject of British writer Alex Pheby's novel Playthings, (2015).
  • BBC documents record that Anthony Burgess wrote in 1975 for Burt Lancaster a screenplay of Schreber's Memoir. Never filmed, it was adapted for radio and performed by Christopher Eccleston 22 March 2020.
  • The two dominant organizations in the anime franchise Neon Genesis Evangelion are named NERV and SEELE, German for Nerve and Soul, likely alluding to Schreber's cosmology.

Dementia praecox

From Wikipedia, the free encyclopedia
A monograph by Eugen Bleuler on dementia praecox (1911)

Dementia praecox (meaning a "premature dementia" or "precocious madness") is a disused psychiatric diagnosis that originally designated a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. Over the years, the term dementia praecox was gradually replaced by the term schizophrenia, which initially had a meaning that included what is today considered the autism spectrum.

The term dementia praecox was first used by German psychiatrist Heinrich Schüle in 1880.

It was also used in 1891 by Arnold Pick (1851–1924), a professor of psychiatry at Charles University in Prague. In a brief clinical report, he described a person with a psychotic disorder resembling "hebephrenia" (an adolescent-onset psychotic condition).

German psychiatrist Emil Kraepelin (1856–1926) popularised the term dementia praecox in his first detailed textbook descriptions of a condition that eventually became a different disease concept later relabeled as schizophrenia. Kraepelin reduced the complex psychiatric taxonomies of the nineteenth century by dividing them into two classes: manic-depressive psychosis and dementia praecox. This division, commonly referred to as the Kraepelinian dichotomy, had a fundamental impact on twentieth-century psychiatry, though it has also been questioned.

The primary disturbance in dementia praecox was seen to be a disruption in cognitive or mental functioning in attention, memory, and goal-directed behaviour. Kraepelin contrasted this with manic-depressive psychosis, now termed bipolar disorder, and also with other forms of mood disorder, including major depressive disorder. He eventually concluded that it was not possible to distinguish his categories on the basis of cross-sectional symptoms.

Kraepelin viewed dementia praecox as a progressively deteriorating disease from which no one recovered. However, by 1913, and more explicitly by 1920, Kraepelin admitted that while there may be a residual cognitive defect in most cases, the prognosis was not as uniformly dire as he had stated in the 1890s. Still, he regarded it as a specific disease concept that implied incurable, inexplicable madness.

History

The history of dementia praecox is really that of psychiatry as a whole.

— Adolf Meyer

First use of the term

Benedict Augustin Morel (1809–1873)

Dementia is an ancient term which has been in use since at least the time of Lucretius in 50 BC where it meant "being out of one's mind". Until the seventeenth century, dementia referred to states of cognitive and behavioural deterioration leading to psychosocial incompetence. This condition could be innate or acquired, and the concept had no reference to a necessarily irreversible condition. It is the concept in this popular notion of psychosocial incapacity that forms the basis for the idea of legal incapacity. By the eighteenth century, at the period when the term entered into European medical discourse, clinical concepts were added to the vernacular understanding such that dementia was now associated with intellectual deficits arising from any cause and at any age. By the end of the nineteenth century, the modern 'cognitive paradigm' of dementia was taking root. This holds that dementia is understood in terms of criteria relating to aetiology, age and course which excludes former members of the family of the demented such as adults with acquired head trauma or children with cognitive deficits. Moreover, it was now understood as an irreversible condition and a particular emphasis was placed on memory loss in regard to the deterioration of intellectual functions.

The term démence précoce was used in passing to describe the characteristics of a subset of young mental patients by the French physician Bénédict Augustin Morel in 1852 in the first volume of his Études cliniques. and the term is used more frequently in his textbook Traité des maladies mentales which was published in 1860. Morel, whose name will be forever associated with religiously inspired concept of degeneration theory in psychiatry, used the term in a descriptive sense and not to define a specific and novel diagnostic category. It was applied as a means of setting apart a group of young men and women with "stupor". As such their condition was characterised by a certain torpor, enervation, and disorder of the will and was related to the diagnostic category of melancholia. He did not conceptualise their state as irreversible and thus his use of the term dementia was equivalent to that formed in the eighteenth century as outlined above.

While some have sought to interpret, if in a qualified fashion, the use by Morel of the term démence précoce as amounting to the discovery of schizophrenia, others have argued convincingly that Morel's descriptive use of the term should not be considered in any sense as a precursor to Kraepelin's dementia praecox disease concept. This is due to the fact that their concepts of dementia differed significantly from each other, with Kraepelin employing the more modern sense of the word and that Morel was not describing a diagnostic category. Indeed, until the advent of Pick and Kraepelin, Morel's term had vanished without a trace and there is little evidence to suggest that either Pick or indeed Kraepelin were even aware of Morel's use of the term until long after they had published their own disease concepts bearing the same name. As Eugène Minkowski stated, "An abyss separates Morel's démence précoce from that of Kraepelin."

Morel described several psychotic disorders that ended in dementia, and as a result he may be regarded as the first alienist or psychiatrist to develop a diagnostic system based on presumed outcome rather than on the current presentation of signs and symptoms. Morel, however, did not conduct any long-term or quantitative research on the course and outcome of dementia praecox (Kraepelin would be the first in history to do that) so this prognosis was based on speculation. It is impossible to discern whether the condition briefly described by Morel was equivalent to the disorder later called dementia praecox by Pick and Kraepelin.

Time component

Karl Ludwig Kahlbaum (1828–1899)

Psychiatric nosology in the nineteenth-century was chaotic and characterised by a conflicting mosaic of contradictory systems. Psychiatric disease categories were based upon short-term and cross-sectional observations of patients from which were derived the putative characteristic signs and symptoms of a given disease concept. The dominant psychiatric paradigms which gave a semblance of order to this fragmentary picture were Morelian degeneration theory and the concept of "unitary psychosis" (Einheitspsychose). This latter notion, derived from the Belgian psychiatrist Joseph Guislain (1797–1860), held that the variety of symptoms attributed to mental illness were manifestations of a single underlying disease process. While these approaches had a diachronic aspect they lacked a conception of mental illness that encompassed a coherent notion of change over time in terms of the natural course of the illness and based upon an empirical observation of changing symptomatology.

In 1863, the Danzig-based psychiatrist Karl Ludwig Kahlbaum (1828–1899) published his text on psychiatric nosology Die Gruppierung der psychischen Krankheiten (The Classification of Psychiatric Diseases). Although with the passage of time this work would prove profoundly influential, when it was published it was almost completely ignored by German academia despite the sophisticated and intelligent disease classification system which it proposed. In this book Kahlbaum categorized certain typical forms of psychosis (vesania typica) as a single coherent type based upon their shared progressive nature which betrayed, he argued, an ongoing degenerative disease process. For Kahlbaum the disease process of vesania typica was distinguished by the passage of the patient through clearly defined disease phases: a melancholic stage; a manic stage; a confusional stage; and finally a demented stage.

In 1866, Kahlbaum became the director of a private psychiatric clinic in Görlitz (Prussia, today Saxony, a small town near Dresden). He was accompanied by his younger assistant, Ewald Hecker (1843–1909), and during a ten-year collaboration they conducted a series of research studies on young psychotic patients that would become a major influence on the development of modern psychiatry.

Together Kahlbaum and Hecker were the first to describe and name such syndromes as dysthymia, cyclothymia, paranoia, catatonia, and hebephrenia. Perhaps their most lasting contribution to psychiatry was the introduction of the "clinical method" from medicine to the study of mental diseases, a method which is now known as psychopathology.

When the element of time was added to the concept of diagnosis, a diagnosis became more than just a description of a collection of symptoms: diagnosis now also defined by prognosis (course and outcome). An additional feature of the clinical method was that the characteristic symptoms that define syndromes should be described without any prior assumption of brain pathology (although such links would be made later as scientific knowledge progressed). Karl Kahlbaum made an appeal for the adoption of the clinical method in psychiatry in his 1874 book on catatonia. Without Kahlbaum and Hecker there would be no dementia praecox.

Upon his appointment to a full professorship in psychiatry at the University of Dorpat (now Tartu, Estonia) in 1886, Kraepelin gave an inaugural address to the faculty outlining his research programme for the years ahead. Attacking the "brain mythology" of Meynert and the positions of Griesinger and Gudden, Kraepelin advocated that the ideas of Kahlbaum, who was then a marginal and little known figure in psychiatry, should be followed. Therefore, he argued, a research programme into the nature of psychiatric illness should look at a large number of patients over time to discover the course which mental disease could take. It has also been suggested that Kraepelin's decision to accept the Dorpat post was informed by the fact that there he could hope to gain experience with chronic patients and this, it was presumed, would facilitate the longitudinal study of mental illness.

Quantitative component

Understanding that objective diagnostic methods must be based on scientific practice, Kraepelin had been conducting psychological and drug experiments on patients and normal subjects for some time when, in 1891, he left Dorpat and took up a position as professor and director of the psychiatric clinic at Heidelberg University. There he established a research program based on Kahlbaum's proposal for a more exact qualitative clinical approach, and his own innovation: a quantitative approach involving meticulous collection of data over time on each new patient admitted to the clinic (rather than only the interesting cases, as had been the habit until then).

Kraepelin believed that by thoroughly describing all of the clinic's new patients on index cards, which he had been using since 1887, researcher bias could be eliminated from the investigation process. He described the method in his posthumously published memoir:

... after the first thorough examination of a new patient, each of us had to throw in a note [in a "diagnosis box"] with his diagnosis written on it. After a while, the notes were taken out of the box, the diagnoses were listed, and the case was closed, the final interpretation of the disease was added to the original diagnosis. In this way, we were able to see what kind of mistakes had been made and were able to follow-up the reasons for the wrong original diagnosis.

The fourth edition of his textbook, Psychiatrie, published in 1893, two years after his arrival at Heidelberg, contained some impressions of the patterns Kraepelin had begun to find in his index cards. Prognosis (course and outcome) began to feature alongside signs and symptoms in the description of syndromes, and he added a class of psychotic disorders designated "psychic degenerative processes", three of which were borrowed from Kahlbaum and Hecker: dementia paranoides (a degenerative type of Kahlbaum's paranoia, with sudden onset), catatonia (per Kahlbaum, 1874) and dementia praecox, (Hecker's hebephrenia of 1871). Kraepelin continued to equate dementia praecox with hebephrenia for the next six years.

In the March 1896 fifth edition of Psychiatrie, Kraepelin expressed confidence that his clinical method, involving analysis of both qualitative and quantitative data derived from long term observation of patients, would produce reliable diagnoses including prognosis:

What convinced me of the superiority of the clinical method of diagnosis (followed here) over the traditional one, was the certainty with which we could predict (in conjunction with our new concept of disease) the future course of events. Thanks to it the student can now find his way more easily in the difficult subject of psychiatry.

In this edition dementia praecox is still essentially hebephrenia, and it, dementia paranoides and catatonia are described as distinct psychotic disorders among the "metabolic disorders leading to dementia".

Kraepelin's influence on the next century

Emil Kraepelin c. 1920

In the 1899 (6th) edition of Psychiatrie, Kraepelin established a paradigm for psychiatry that would dominate the following century, sorting most of the recognized forms of insanity into two major categories: dementia praecox and manic-depressive illness. Dementia praecox was characterized by disordered intellectual functioning, whereas manic-depressive illness was principally a disorder of affect or mood; and the former featured constant deterioration, virtually no recoveries and a poor outcome, while the latter featured periods of exacerbation followed by periods of remission, and many complete recoveries. The class, dementia praecox, comprised the paranoid, catatonic and hebephrenic psychotic disorders, and these forms were found in the Diagnostic and Statistical Manual of Mental Disorders until the fifth edition was released, in May 2013. These terms, however, are still found in general psychiatric nomenclature.

Change in prognosis

In the seventh, 1904, edition of Psychiatrie, Kraepelin accepted the possibility that a small number of patients may recover from dementia praecox. Eugen Bleuler reported in 1908 that in many cases there was no inevitable progressive decline, there was temporary remission in some cases, and there were even cases of near recovery with the retention of some residual defect. In the eighth edition of Kraepelin's textbook, published in four volumes between 1909 and 1915, he described eleven forms of dementia, and dementia praecox was classed as one of the "endogenous dementias". Modifying his previous more gloomy prognosis in line with Bleuler's observations, Kraepelin reported that about 26% of his patients experienced partial remission of symptoms. Kraepelin died while working on the ninth edition of Psychiatrie with Johannes Lange (1891–1938), who finished it and brought it to publication in 1927.

Cause

Though his work and that of his research associates had revealed a role for heredity, Kraepelin realized nothing could be said with certainty about the aetiology of dementia praecox, and he left out speculation regarding brain disease or neuropathology in his diagnostic descriptions. Nevertheless, from the 1896 edition onwards Kraepelin made clear his belief that poisoning of the brain, "auto-intoxication," probably by sex hormones, may underlie dementia praecox – a theory also entertained by Eugen Bleuler. Both theorists insisted dementia praecox is a biological disorder, not the product of psychological trauma. Thus, rather than a disease of hereditary degeneration or of structural brain pathology, Kraepelin believed dementia praecox was due to a systemic or "whole body" disease process, probably metabolic, which gradually affected many of the tissues and organs of the body before affecting the brain in a final, decisive cascade. Kraepelin, recognizing dementia praecox in Chinese, Japanese, Tamil and Malay patients, suggested in the eighth edition of Psychiatrie that, "we must therefore seek the real cause of dementia praecox in conditions which are spread all over the world, which thus do not lie in race or in climate, in food or in any other general circumstance of life..."

Treatment

Kraepelin had experimented with hypnosis but found it wanting, and disapproved of Freud's and Jung's introduction, based on no evidence, of psychogenic assumptions to the interpretation and treatment of mental illness. He argued that, without knowing the underlying cause of dementia praecox or manic-depressive illness, there could be no disease-specific treatment, and recommended the use of long baths and the occasional use of drugs such as opiates and barbiturates for the amelioration of distress, as well as occupational activities, where suitable, for all institutionalized patients. Based on his theory that dementia praecox is the product of autointoxication emanating from the sex glands, Kraepelin experimented, without success, with injections of thyroid, gonad and other glandular extracts.

Use of term spreads

"Psychiatrists of Europe! Protect your sanctified diagnoses!" A satirizing cartoon by Emil Kraepelin based on a famous contemporary political painting (Below).
The political painting Völker Europas, wahrt eure heiligsten Güter ("People of Europe, defend your sacred treasures!")

Kraepelin noted the dissemination of his new disease concept when in 1899 he enumerated the term's appearance in almost twenty articles in the German-language medical press. In the early years of the twentieth century the twin pillars of the Kraepelinian dichotomy, dementia praecox and manic depressive psychosis, were assiduously adopted in clinical and research contexts among the Germanic psychiatric community. German-language psychiatric concepts were always introduced much faster in America (than, say, Britain) where émigré German, Swiss and Austrian physicians essentially created American psychiatry. Swiss-émigré Adolf Meyer (1866–1950), arguably the most influential psychiatrist in America for the first half of the 20th century, published the first critique of dementia praecox in an 1896 book review of the 5th edition of Kraepelin's textbook. But it was not until 1900 and 1901 that the first three American publications regarding dementia praecox appeared, one of which was a translation of a few sections of Kraepelin's 6th edition of 1899 on dementia praecox.

Adolf Meyer was the first to apply the new diagnostic term in America. He used it at the Worcester Lunatic Hospital in Massachusetts in the fall of 1896. He was also the first to apply Eugen Bleuler's term "schizophrenia" (in the form of "schizophrenic reaction") in 1913 at the Henry Phipps Psychiatric Clinic of the Johns Hopkins Hospital.

The dissemination of Kraepelin's disease concept to the Anglophone world was facilitated in 1902 when Ross Diefendorf, a lecturer in psychiatry at Yale, published an adapted version of the sixth edition of the Lehrbuch der Psychiatrie. This was republished in 1904 and with a new version, based on the seventh edition of Kraepelin's Lehrbuch appearing in 1907 and reissued in 1912. Both dementia praecox (in its three classic forms) and "manic-depressive psychosis" gained wider popularity in the larger institutions in the eastern United States after being included in the official nomenclature of diseases and conditions for record-keeping at Bellevue Hospital in New York City in 1903. The term lived on due to its promotion in the publications of the National Committee on Mental Hygiene (founded in 1909) and the Eugenics Records Office (1910). But perhaps the most important reason for the longevity of Kraepelin's term was its inclusion in 1918 as an official diagnostic category in the uniform system adopted for comparative statistical record-keeping in all American mental institutions, The Statistical Manual for the Use of Institutions for the Insane. Its many revisions served as the official diagnostic classification scheme in America until 1952 when the first edition of the Diagnostic and Statistical Manual: Mental Disorders, or DSM-I, appeared. Dementia praecox disappeared from official psychiatry with the publication of DSM-I, replaced by the Bleuler/Meyer hybridization, "schizophrenic reaction".

Schizophrenia was mentioned as an alternate term for dementia praecox in the 1918 Statistical Manual. In both clinical work as well as research, between 1918 and 1952 five different terms were used interchangeably: dementia praecox, schizophrenia, dementia praecox (schizophrenia), schizophrenia (dementia praecox) and schizophrenic reaction. This made the psychiatric literature of the time confusing since, in a strict sense, Kraepelin's disease was not Bleuler's disease. They were defined differently, had different population parameters, and different concepts of prognosis.

The reception of dementia praecox as an accepted diagnosis in British psychiatry came more slowly, perhaps only taking hold around the time of World War I. There was substantial opposition to the use of the term "dementia" as misleading, partly due to findings of remission and recovery. Some argued that existing diagnoses such as "delusional insanity" or "adolescent insanity" were better or more clearly defined. In France a psychiatric tradition regarding the psychotic disorders predated Kraepelin, and the French never fully adopted Kraepelin's classification system. Instead the French maintained an independent classification system throughout the 20th century. From 1980, when DSM-III totally reshaped psychiatric diagnosis, French psychiatry began to finally alter its views of diagnosis to converge with the North American system. Kraepelin thus finally conquered France via America.

From dementia praecox to schizophrenia

Due to the influence of alienists such as Adolf Meyer, August Hoch, George Kirby, Charles Macphie Campbell, Smith Ely Jelliffe and William Alanson White, psychogenic theories of dementia praecox dominated the American scene by 1911. In 1925 Bleuler's schizophrenia rose in prominence as an alternative to Kraepelin's dementia praecox. When Freudian perspectives became influential in American psychiatry in the 1920s schizophrenia became an attractive alternative concept. Bleuler corresponded with Freud and was connected to Freud's psychoanalytic movement, and the inclusion of Freudian interpretations of the symptoms of schizophrenia in his publications on the subject, as well as those of C.G. Jung, eased the adoption of his broader version of dementia praecox (schizophrenia) in America over Kraepelin's narrower and prognostically more negative one.

The term "schizophrenia" was first applied by American alienists and neurologists in private practice by 1909 and officially in institutional settings in 1913, but it took many years to catch on. It is first mentioned in The New York Times in 1925. Until 1952 the terms dementia praecox and schizophrenia were used interchangeably in American psychiatry, with occasional use of the hybrid terms "dementia praecox (schizophrenia)" or "schizophrenia (dementia praecox)".

Diagnostic manuals

Editions of the Diagnostic and Statistical Manual of Mental Disorders since the first in 1952 had reflected views of schizophrenia as "reactions" or "psychogenic" (DSM-I), or as manifesting Freudian notions of "defense mechanisms" (as in DSM-II of 1969 in which the symptoms of schizophrenia were interpreted as "psychologically self-protected"). The diagnostic criteria were vague, minimal and wide, including either concepts that no longer exist or that are now labeled as personality disorders (for example, schizotypal personality disorder). There was also no mention of the dire prognosis Kraepelin had made. Schizophrenia seemed to be more prevalent and more psychogenic and more treatable than either Kraepelin or Bleuler would have allowed.

Conclusions

As a direct result of the effort to construct Research Diagnostic Criteria in the 1970s that were independent of any clinical diagnostic manual, Kraepelin's idea that categories of mental disorder should reflect discrete and specific disease entities with a biological basis began to return to prominence. Vague dimensional approaches based on symptoms—so highly favored by the Meyerians and psychoanalysts—were overthrown. For research purposes, the definition of schizophrenia returned to the narrow range allowed by Kraepelin's dementia praecox concept. Furthermore, after 1980 the disorder was a progressively deteriorating one once again, with the notion that recovery, if it happened at all, was rare. This revision of schizophrenia became the basis of the diagnostic criteria in DSM-III (1980). Some of the psychiatrists who worked to bring about this revision referred to themselves as the "neo-Kraepelinians".

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