Unitary psychosis
[2] The prevalence of the concept in Germany during the mid-19th century can be understood in terms of a general resistance to Cartesian dualism and faculty psychology as expressed in Naturphilosophie and other Romantic doctrines that emphasised the unity of body, mind and spirit.
"[7] Mental illness would then unfold along seven successive stages of progressive deterioration, which he detailed as: hyperphrénie (mania); paraphrénie (folie); hyperplexie (stupidity); hyperspasmie (epilepsy); ideosynchysie (hallucinations); analcouthie (confusion); and noasthénie (dementia).
[10] His adoption of the concept of unitary madness was predicated on his belief in the unity of the human soul or character and that man was at once composed of both material and spiritual elements.
[14] Instead, he held that the psychological pain occasioned by remorse, guilt, poverty and social reversal was the universal causal factor in all forms of mental morbidity.
[12] A convinced somaticist and commonly considered one of the founders of materialist psychiatry,[16] in the 1845 text which established him as one of the leading scientific psychiatrists of his era, Pathologie und Therapie der psychischen Krankheiten, he conceived of character, or "psychological tonus", as derived from the action of a postulated "psychic reflex action" (psychische Reflexaktion) produced by the stimulus of the accumulated representations (Vorstellungen) of the individual's life experience.
[1] He argued, based on his observation of cases, that the former condition preceded the latter where disorders of the intellect and will appeared "only as consequences and terminations" of disturbances of the emotions if "the cerebral affliction has not been cured".
[31] Its wider support among asylum-based alienists (as medical practitioners in mental hospitals were then known) as opposed to academic psychiatrists was due to the fact that it was more applicable to the unhurried tempo of asylum routine where, unlike in university clinics, there was no perceived need for rapid diagnosis.
Karl Ludwig Kahlbaum (1829–1899), a German psychiatrist of seminal importance in the development of the modern nosology and a formative influence on the work of Emil Kraepelin,[32] had taken issue with Neumann's assertion in his 1859 text that mental illness could not be categorised into discrete disease entities.
"[35] For Kahlbaum, Neumann's failure to engage in any attempt at disease classification, his rejection of diagnosis as abstraction and his focus only upon the individual manifestation of mental illness constituted an enterprise without any scientific validity.
[36] In the absence of meaningful and acute diagnostic categories in psychiatry Kahlbaum believed that both the development of effective therapeutic practices and the knowledge of mental illness would run stagnant.
[36] During his inaugural lecture following his appointment to the chair of psychiatry in Dorpat University in 1887, Kraepelin contended that Zeller's notion of unitary psychosis had led to the calcification of clinical research in Germany until as late as the 1860s.
The revival of a more objective clinical approach built upon observation, he contended, had had to await the contribution of researchers such as Ludwig Snell who wrote on monomania as a distinct disease entity in the 1870s.
This division of the psychoses, currently enshrined in modern classification systems as that between schizophrenia and bipolar disorder and referred to as the Kraepelinian dichotomy, has remained in place for more than a hundred years.
[42] He also held the belief, derived from his clinical experience, that symptoms associated with particular diagnostic categories were fluid and that a patient could, for instance, exhibit signs of mania or depression which might then reappear periodically and subsequently develop delusions and undergo a deterioration in personality.
