A New Look at Mental Disorders


by Robert Gallon, PhD

Although I’ve written a long book focused on mental disorders, I don’t really believe in them. At least, I don’t believe that mental disorders are quasi-diseases that cause people’s problems and that doctors can diagnose. Nor are mental disorders discrete biological abnormalities like chemical imbalances that can be cured by the right medications.

The language of medicine is misleading. There are no true diseases in psychiatry. In the history of medicine, whenever an objective biological cause is found for some mental impairment, it leaves the realm of psychiatry and becomes part of neurology or internal medicine.

In the past, what we now recognize as stroke, seizure, dementia and many other brain diseases were seen as psychiatric conditions. Few would call them that now. Schizophrenia, bipolar disorder and anxiety remain mental disorders precisely because they are not diseases. I have no doubt, though, that in the future there will be new diseases identified that will come to describe various brain conditions now seen as psychiatric.

A little history

The first psychiatrist to attempt a formal classification system for madness was Emil Kraepelin who, incidentally, was born in 1856, the same year as Sigmund Freud. In the late 1800s, the mental asylums were filled to the bursting with seemingly permanent patients. Kraepelin was a psychiatrist of the asylum where the poor and the undesirable were confined as well as a professor at Heidelberg University. His life’s work was to classify mental disorders as “disease entities” in a manner that emulated the “hard” medical sciences of neurology and pathology.

What he did was to distill the case studies of thousands of hospitalized patients into core signs of mental illness and chart each patient’s course over many years. He had his residents fill out an index card on each patient and put the card in a ‘diagnosis box’. Kraepelin had a platform for his work because he had published a Textbook of Psychiatry and he announced his initial conclusions in the fourth edition of 1893.

As he reshuffled his index cards, Kraepelin concluded that there were only two major forms of mental disease and one minor one. The one with the poorest outcome he called Dementia Praecox, a term he based on his colleague Alois Alzheimer’s studies of senile dementia. In Kraepelin’s view, Dementia Praecox was an irreversible mental deterioration beginning at a young age. He had a very negative view of these patients who he described as “symptom carriers”. He described their symptoms using terms such as “atrophy of emotions” and “vitiation shun of the will”.

His second major mental disease he called circular insanity, which encompassed all types of mood disturbance. These patients had some hope of recovery and could be treated. Having only two types of insanity certainly simplified diagnosis and decision-making. Dementia praecox was incurable, so the asylum’s role was to warehouse these patients and no treatment was offered.

In the early 20th century, Kraepelin’s diagnostic labels would be changed to schizophrenia and manic depressive illness. Kraepelin’s ideas about a biological cause for mental disturbance was gradually supplanted by Freud’s psychogenic explanations, but his influence lived on through the early decades of the century.

They had a large influence on the Eugenics Movement of the 1920s and 1930s, which viewed the insane as carrying defective ‘germplasm’. In the US, the Eugenics Record Office kept track of the burden such misfits placed on society and one advisory panel recommended that 10% of the population should be sterilized.

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