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The development of Kraepelin’s mature diagnostic concept of hebephrenia: a close reading of relevant texts of Hecker, Daraszkiewicz, and Kraepelin

Molecular Psychiatry volume 25, pages 180–193 (2020)Cite this article

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Abstract

In developing his mature concept of hebephrenic dementia praecox (DP) in his 4th (1893) through 6th textbook editions (1899), Kraepelin worked from the hebephrenic syndrome first described by Hecker (1871) and then carefully studied by his student Daraszkiewicz (1892). Working under Kraepelin’s supervision, Daraszkiewicz followed Hecker in emphasizing several key features of hebephrenia (distinctive deteriorative course, importance of silliness and minimal positive psychotic symptoms) but expanded the syndrome to include cases developing severe dementia, rejected the link to prodromal depressive and manic phases, and reduced the emphasis on thought disorder. Daraszkiewicz proposed a soft subtyping of hebephrenia based on level of deterioration, which Kraepelin adopted in his 4th edition with an additional emphasis on severe positive psychotic symptoms. In his 5th edition, Kraepelin created a third subform with even more pronounced and bizarre delusions and hallucinations. In his 6th edition, which contained his first articulation of DP, Kraepelin eliminated his hebephrenia subforms presenting a single syndrome, which, compared to Hecker, included more emphasis on positive psychotic and catatonic symptoms and severe dementia. Kraepelin’s paths to hebephrenic and paranoid DP differed in important ways. Paranoid DP was a de novo syndrome created by differentiation from paranoia. Hebephrenia, by contrast, evolved from a disorder created in the Kahlbaum/Hecker paradigm of the iterative study of clinical features, course and outcome. Kraepelin further implemented this approach in substantially reworking, over several drafts, the hebephrenic syndrome to fit into his emerging construct of dementia praecox.

I began a project to understand the origin of Kraepelin’s concept of dementia praecox (DP) by tracing, in his texts, the origins of his mature view of paranoid DP [1]. I continue this work here, focusing on hebephrenia. I begin with Hecker’s 1871 monograph [2,3,4] proposing the syndrome, examine the key 1892 monograph by Kraepelin’s student Daraszkiewicz [5] and review Kraepelin’s description of the syndrome in the 4th through 6th textbook editions. To increase concision, longer quotes are in Table 1. Key signs and symptoms of hebephrenia as described by these authors are summarized in Table 2. Translations of the Daraszkiewicz and 4th and 5th Kraepelin editions were performed by Ms. Astrid Klee with proposed revisions by KSK that were subsequently discussed. Klee also revised the extant English translation of Kraepelin’s 6th edition [6].

Table 1 Extended quotes from Hecker, Daraszkiewicz, and Kraepelin on hebephrenia
Full size table
Table 2 Estimated diagnostic importance of key symptoms and signs of hebephrenia as described by Hecker, Daraszkiewicz, and Kraepelin
Full size table

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Acknowledgements

Translations from the German used in this report were performed in collaboration with Ms. Astrid Klee. Dr. Joel Braslow provided helpful comments on earlier versions of this manuscript and references to US state hospital reports. Dr. Eric Engstrom guided me to key historical documents.

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  1. Virginia Institute of Psychiatric and Behavioral Genetics, and Departments of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA

    Kenneth S. Kendler

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Kendler, K.S. The development of Kraepelin’s mature diagnostic concept of hebephrenia: a close reading of relevant texts of Hecker, Daraszkiewicz, and Kraepelin. Mol Psychiatry 25, 180–193 (2020). https://doi.org/10.1038/s41380-019-0411-7

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