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In the recent history of ideas about psychopathology, two models of health-illness processes stand preeminent. Freud's model of the mind and of symptoms stands on one part of the intellectual terrain and Kraepelin's on another. These two models have often been separated rather than being connected by intellectual bridges. Neither descriptive psychiatrists nor psychoanalysts have shown sustained enthusiasm for bridge building. For example, in his History of Psychiatry published in 1966, Franz Alexander commented:
From the vantage point of our present dynamic era in psychiatry, Kraepelin's monumental contributions require a reevaluation. There can be no doubt, however, that he succeeded in bringing into a chaotic accumulation of clinical observation a system of distinct disease entites that has stood up remarkably well in to the present era. Unfortunately, his systemization eventually hindered the deeper understanding of mental disturbances. What once in the past meant progress, when compared with subsequent developments often served as a retarding influence. The propensity of the human mind to adhere rigidly to knowledge arduously achieved in the past often interfers with further advancements. The changes in the evaluation of Kraepelin's work is one of the most striking examples of this historical sequence. He whose authority ruled supreme at the turn of the century and the following decades, whose texbook became the bible of modern psychiatry, today is looked upon by the younger generation of psychiatrists as a rigid and sterile codifier of disease categories; even if these were valid they contribute to neither understanding the causes of diseases not their prognosis. His
Dr. Friedman is Associate Attending Psychiatrist, Roosevelt Hospital, New York, and Clinical Associate Professor of Psychiatry, College of Physicians and Surgeons, Columbia University.
Ms. Corn is Assistant Director Social Work Services Department, New York Hospital-Cornell Medical Center, Westchester
PageDr. Friedman is Associate Attending Psychiatrist, Roosevelt Hospital, New York, and Clinical Associate Professor of Psychiatry, College of Physicians and Surgeons, Columbia University.
Ms. Corn is Assistant Director Social Work Services Department, New York Hospital-Cornell Medical Center, Westchester