Abstract
Background: Historical accounts of psychiatric classifications have hitherto been written in terms of a ‘received view’. This contains two assumptions, that: (i) the activity of classifying is inherent to the human mind; and (ii) psychiatric ‘phenomena’ are stable natural objects.
Objectives: The aim of this article is to provide an outline of the evolution of psychiatric classifications from the perspective of conceptual history. This is defined as a theoretical and empirical inquiry into the principles, sortal techniques and contexts in which alienists carried out their task. It assumes that all psychiatric classifications are cultural products, and endeavours to answer the question of whether classificatory models imported from the natural sciences can be applied to man-made constructs (such as mental illness) definitionally based on ‘personalised semantics’. Methods: Exemplars of classificatory activity are first mapped and contextualised. Then, it is suggested that in each historical period crafting classifications has been like playing a game of chess with each move being governed by rules. This is illustrated by offering an analysis of the 1860–1861 French debate on classification. Results and Conclusions: (1) Medicine is not a contemplative but a modificatory activity and hence classifications are only valuable if they can release new information about the object classified. (2) It should not be inferred from the fact that psychiatric classifications are not working well (i.e. that they only behave as actuarial devices) that they must be given up. Conceptual work needs to continue to identify ‘invariants’ (i.e. stable elements that anchor classifications to ‘nature’. (3) Because mental disorders are more than unstable behavioural epiphenomena wrapped around stable molecular changes, ‘neurobiological’ invariants may not do. Stability depends upon time frames. Furthermore, it is unlikely that gene-based classifications will ever be considered as classifications of mental disorders. For once, they would have low predictive power because of their lack of information about the defining codes of mental illness. ‘Social’ and ‘psychological’ invariants have problems of their own.
Notes
*This article is dedicated to Dr Mikulá'sTeich, one of the great historians of science of the 20th century, on his 80th birthday. I have had the privilege of enjoying, first at Oxford and then at Cambridge, the pleasures of his teaching and friendship.
1. Reprint requests to G.E. Berrios, Department of Psychiatry University of Cambridge, Addenbrooke's Hospital, Hills Road, CB2 2QQ, UK. Email: <[email protected]>
2. See, for example, Viejo JL. El Hombre como Animal: el Antropocentrismo en la Zoologia. Asclepio 1996; 48:53–71; and Foucault M. Les Mots et les Choses. Paris: Gallimard, 1966.
3. Durkheim E, Mauss M. Primitive classification. (Translated from the French by R. Needham.) London: Cohen & West, 1963 (first published in 1901–1903).
4. See, for example: Temkin O. The history of classification in medical sciences. In: Katz MM, Cole JO, Barton WE, (eds). The role and methodology of classification in psychiatry and psychopathology. Washington, DC: US Department of Health, Education and Welfare, 1965:11–25; Chapter 10, in Lorr M, et al. Syndromes of psychosis. Oxford: Pergamon Press, 1963; Fischer-Homberger E. Eighteenth century nosology and its survivors. Medical History 1970; 14:397–403.
5. Slaughter MM. Universal languages and scientific taxon omy in the seventeenth century. Cambridge: Cambridge University Press, 1982.
6. See Flint R. A history of classification of the sciences. Edinburgh: William Blackwood, 1904; Larson JL. Reason and experience. The representation of natural order in the work of Carl von Linné. Los Angeles: University of California Press, 1904. Berg F. Linné et Sauvages. Lychnos 1956; 16:31–54.
7. Even great men gave way to the new ideas. For example, in 1749 Buffon was very sceptical about classifying living beings but by 1761 he had been converted (p.566, in Roger J. Les Sciences de la Vie dans la Pensée Française du XVIII Siècle. Paris: Albin Michel, 1993; first edition 1963). For a magisterial treatment of this topic see Chapter VI: ‘The Problem of Classifying and Systemizing Natural Forms’ (pp.118–136) in Cassirer E. The problem of knowledge. Philosophy, science, and history since Hegel. New Haven: Yale University Press, 1950; and Riese W. History and principles of classification of nervous diseases. Bulletin of the History of Medicine 1945; 18:465–512.
8. Whether such beliefs concern classification or categorisation remains unclear. At any rate, the underlying rules and mechanisms are far from being understood (on this see the brilliant: Estes WK. Classification and cognition. Oxford: Oxford University Press, 1994).
9. The ‘Kantian revolution’was partially about the identification of general categories in terms of which knowledge might be organised.
10. For example, Mill stated that naming something as X is already classifying for two classes follow: X and not X (p.76, Mill JS. A system of logic. London: Longmans, Green, and Co., 1898).
11. Such was the belief in the ‘naturalness’of classifying that at the 1860–1861 SMPdebate on classification Jules Fairet stated with incredulity: ‘even in the present, some people are still inclined to deny the importance of classification in the sciences and consider them as sterile … to think like this is to deny the essential nature of the human mind and its instinctive tendency to group objects by analogy, and separate them by differences and to search for the general laws that allow the organization of multiplicity … This tendency is so totally inherent to the human mind and its nature so absolute that it shows itself both in the child and in the primitive man …’(pp.145–146, in Reports. Meeting of 26 November 1860, Annales Médico-Psychologiques 1861; 7:143–177. For a recent review of classification as a ‘cognitive activity'see Jablensky A. Methodological issues in psychiatric classification. British Journal of Psychiatry 1988; 152(Suppl. 1):15–20.
12. During the 18th century classifications were also caught up in the issue of whether the mind was capable of penetrating nature or whether divisions were only in the mind of man (see Jordanova LJ. Lamark. Oxford: Oxford University Press, 1984). In regards to the origin of the concept of ‘privileged features’, it is likely that this originated from Locke's view that: ‘because nature contains only many particulars resembling each other in many ways we must decide which differences between individuals objects, whether grossly salient or barely noticeable, to include in our abstract ideas of them and thus in our definitions of general terms’(p.145, Guyer P. Locke's philosophy of language' in Chappell V, ed. The Cambridge companion to Locke. Cambridge: Cambridge University Press, 1994:115–145.
13. See Larson JL. (1971) ibid.
14. Adanson M. Preface Istorike sur l'état ancien et actuel de la Botanike, et une Téorie de cette science. In: Familles des Plantes, First Part. Paris: Vincent, 1763:i–cccxxv.
15. Vernon K. The founding of numerical taxonomy. British Journal for the History of Science 1988; 21:143–159.
16. Mechelen I van, Hampton J, Muchalski RS, Theuns P, eds. Categories and concepts. London: Academic Press, 1993. On the role of concepts in classifications see the excellent: Malmgren H. Psychiatric classification and empiricist theories of meaning. Acta Psychiatrica Scandinavica 1993; 373(Suppl.):48–64; and on the cultural contextualisation of psychiatric classifications see: Gaines AD. From DSM I to III-R: voices of self, mastery and the other: a cultural constructivist reading of US psychiatric classification. Social Science and Medicine 1992; 35:3–24.
17. On a strong criticism of such a view and of the cognitive science that has developed out of it see: Fodor JA. Concepts. Where cognitive science went wrong. Oxford: Clarendon Press, 1998; and his recent simplified version in: Fodor J. When is a dog a DOG. Nature 1998; 396:325–327.
18. On this see Landesman C. Locke's theory of meaning. Journal of the History of Philosophy 1976; 14:23–35.
19. On this see the full debate at the Société Médico-Psychologique (Annales Médico-Psychologiques 7:128–143; 145–171; 316–326, etc.). Because the idea of directly applying the scientific ‘principles of classification’to medicine and psychiatry is old, it is the more surprising that its iteration at the New York meeting (February 1959) of the American Psychopathological Association by Carl Hempel (Zubin J, ed. Field studies in the mental disorders. New York; Grune and Stratton, 1961; and Chapter 6 in Hempel CG. Aspects of scientific explanation and other essays in the philosophy of science. New York: The Free Press, 1965:137–154) left most psychiatrists mesmerised and many to this day seem to believe that it was a portentous discovery (e.g. p.2 in ‘Introduction’to Sadler JZ, Wiggins OP, Schwartz MA, eds. Philosophical perspectives on psychi atric diagnostic classification. Baltimore: The Johns Hopkins University Press, 1994; p.25 in Kendell RE. The role of diagnosis in psychiatry. Oxford: Blackwell Science, 1994. It is a pity that this error has not been corrected in recent books, e.g. Tischler GL, ed. Diagnosis and class ification in psychiatry. Cambridge: Cambridge University Press, 1987; Mezzich JE et al., eds. International class ification in psychiatry. Cambridge: Cambridge University Press, 1987; Sartorius N et al., eds. Sources and traditions of classification in psychiatry. Toronto: Hogrefe and Huber, 1990. For an excellent critical analysis of the tout court position see: Schwartz MA, Wiggins OP. Logical empiricism and psychiatric classification. Comprehensive Psychiatry 1986; 27:101–114.
20. Modification of the ‘general taxonomic principles’of science is required for they were extracted from formal classifications of static objects and hence cannot apply to classifications of fluent and less stable ideal objects such as mental disorders, social mores, etc. On occasions, an escape clause might be used that ‘medical classifications are eclectic and pragmatic’(e.g. Jablenski A. Current trends in the methodology of classification. Acta Psychiatrica Belga 1986; 86:556–567.
21. Ellenberger H. Les illusions de la classification psychiatrique. L'Evolution Psychiatrique 1963; 28:221–248.
22. Psychoanalysis has inspired various members of this group; e.g. ‘But as we came to better understanding of its nature [mental illness] we have been able to discard most of the fictions which we have used during the long reaches of more incomplete knowledge’(p.419, in Menninger K. The vital balance. New York: The Viking Press, 1964). Also see Ellenberger (1963) ibid.
23. To this level of the debate, the pragmatic or empirical argument that we ‘need to classify’in order to organise hospitals, finances or clinical care is not very relevant.
24. This view underlies papers providing methodological recipes (e.g. Pfohl B, Andreasen NC. Development of classifications systems in psychiatry. Comprehensive Psychiatry 1978; 19:197–207; for a criticism of this approach see: Katschnig H, Simhandl C. New developments in the classification and diagnosis of functional mental disorders. Psychopathology 1986; 19:219–235).
25. For modern approaches to the philosophy of classification that go beyond Hempel see: Douglas M, Hull D, eds. How classification works. Nelson Goodman among the social sci ences. Edinburgh: Edinburgh University Press, 1992; Blashfield RK. The classification of psychopathology. New York: Plenum Press, 1992; Rorsch E, Lloyd BB, eds. Cognition and categorization. New Jersey: Lawrence Erlbaum, 1978. For a revealing analysis of classifications as compared with tests see: Blashfield RK, Livesley WJ. Metaphorical analysis of psychiatric classification as a psychological test. Journal of Abnormal Psychology 1991; 100:262–270.
26. Surprisingly, not many exist. It is important here to separate ‘catalogues’from conceptual histories which contextualise ideas and classification rules. Examples of catalogues are: Menninger (1964) ibid.: Sartorius N et al., eds. 1990, ibid.; de Boor W. Psychiatrische systematik. Berlin: Springer, 1954. More difficult to characterise, due to their linearity and decontextualised nature, are works such as Mack AH, Forman L, Brown R, Frances A. A brief history of psychiatric classification. From the ancients to DSM IV. Psychiatric Clinics of North America 1994; 17:515–523.
27. In the same way as 20th century national psychiatric institutions and countries have felt obliged to provide theirs.
28. ‘Fashion’plays a central role in theories of social change. There are two main accounts of its mechanisms: psycho logical, which seeks them inside people's heads (e.g. fashion is seen as something which satisfies the individual's need to integrate himself into a group, etc.), and sociologi cal, which sees fashion as a social mechanism dedicated to facilitating change. Georg Simmel (1858–1918), one of its sponsors, believed that one of the objectives of fashion was to maintain the identity of social classes in the midst of change. Thomas Kuhn's notion of ‘paradigm shift’might thus be regarded as the application of the sociological theory of fashion to scientific change.When applied to psychiatry, ‘fashion’invites to search for social mechanisms. These are not hard to find as it is increasingly clear that the pharmaceutical and medical insurance industry may play a role in the ‘choice’of clinical classes (as in the case of DSM-IIV). It can also be predicted that the neuroimaging and genetic industry will soon play a similar role: new ‘diseases’will be defined in terms of these techniques and the pressure will be on to include them in the classifications of the future. Although prima facie this is to benefit patients, there is little doubt that the medicolegal obligation to diagnose what is in the official classifications will force psychiatric centres in the world to buy the required equipment.The crucial question is how fashion controls the behaviour of those who follow it. While a mechanism of cognitive or perceptual control seems attached to concepts such as ‘mentalité’, ‘episteme’and ‘paradigm’(e.g. people controlled by a paradigm will ‘see’the world in a particular way), fashion requires subjects to become ‘aware’that a change in belief or action is desirable and in the event ‘choose’to proceed. Both the strong and weak versions can be applied to psychiatric classification. If the former, writings are platitudinous and repetitive because that is the only way they can see it (and also because there are only a few ways in which it can be said). If the latter, then psychiatrists choose to talk about PC in a particular way but it is possible for them to ‘see’it differently. I suspect that latter is a more constructive approach to take than the former.
29. Blashfield (1984) ibid.
30. On this see: Berrios GE, Chen E. Symptom-recognition and neural-networks. British Journal of Psychiatry 1993; 163:308–314.
31. Raven PH, Berlin B, Breedlove DE. The origins of taxonomy. Science 1971; 174:1210–1213.
32. Anderson TW. Classification and discrimination. In: Sills DL, ed. International encyclopaedia of the social sciences. London: Macmillan 1968:553–559.
33. Fleming W. Vocabulary of philosophy. London: Ricard Griffin and Company, 1857:91–92.
34. Bonnet Ch. Œuvres d'histoire naturelle et de philosophie. Vol 17. Neuchatel: Samuel Fauche, 1783:320.
35. Sydenham T. The works of Thomas Sydenham MD. 2Vols. London: Printed for the Sydenham Society, 1848:15. Sydenham's approach has been called more botanico, i.e. ‘in the fashion of botany’and was firmly held by 18th century nosologists (see: López Piñero JJ. Historical origins of the concept of neuroses. Cambridge: Cambridge University Press, 1983). In this regard, Linneé's epigram is also well known: ‘Symptomata se habent ad morbum ut folia et fulcra ad plantam’. At the beginning of the 19th century, Pinel was still stating: ‘The revolution brought about by Linneé in natural history, together with the introduction of a method to offer descriptions that be short and exact, could not but greatly influence medicine’. (see p.ixxxiv, Vol 1, Pinel Ph. Nosographie Philosophique. 3 Vols. 5th Edition. Paris: JA Brosson, 1813.
36. The issue of the ‘reality’of the concept of species remains unresolved. Darwin himself looked: ‘at the term species, as one arbitrarily given for the sake of convenience to a set of individuals closely resembling each other.’(p.108, Darwin C. The origin of species. Harmonsworth: Penguin, 1970, 1st edition 1859). For a discussion of the current state of systematics see: Sober E. Philosophy of biology. Oxford: Oxford University Press, 1993.
37. For a recent proposal for a polythetic classification see: Corning WC, Steffy RA. Taximetric strategies applied to psychiatric classification. Schizophrenic Bulletin 1979; 5:294–305.
38. But unfortunately problems exist as to the definition of ‘natural kinds’. See: Granger H. The scala naturae and the continuity of kinds. Phronesis 1985; 30:181–200; Dupré J. Natural kinds and biological taxa. Philosophical Review 1981; 90:66–90; Wilkerson T. Species, essences, and the names of natural kinds. Philosophical Quarterly 1993; 43:1–19.
39. Dagognet F. Le catalogue de la vie. Paris: Presses Universitaires de France, 1970. For a recent example of a proposal for an artificial classification, i.e. one that emphasises certain features of ‘questions’, see: Mellergård M. Psychiatric classifications as a reflection of uncertainties. Acta Psychiatrica Scandinavica 1987; 76:106–111.
40. See: Berrios GE, Hauser R. The early development of Kraepelin's ideas on classification. Aconceptual history. Psychological Medicine 1988; 18:813–821. For a retrospective diagnostic ascertainment of a selected cluster of Kraepelin's patients see: Jablensky A, Hugler H, von Cranach M, Kalinov K. Kraepelin revisited: a reassessment and statistical analysis of dementia praecox and manic depressive insanity in 1908. Psychological Medicine 1993; 23:843–858. On the origin of the categories themselves and the small role played by empirical research in Kraepelin's classification see: Weber MM, Engstrom EJ. Kraepelin's ‘diagnostic cards’: the confluence of clinical research and preconceived categories. History of Psychiatry 1997; 8:375–385.
41. In this regard, Jaspers' views are well known: ‘The principle of medical diagnosis is that all the disease phenomena should be characterized within a single diagnosis. Where a number of different phenomena co-exist the question arises which of them should be preferred for diagnostic purposes so that the remaining phenomena can be considered secondary or accidental.’(pp.611–612, in Jaspers K. General psychopathology. Translated by J Hoenig and MW Hamilton. Manchester: Manchester University Press, 1963).
42. p.317 in Windelband W. Historia y Ciencia de la Naturaleza. In Preludios filosóficos. Translation of Wenceslao Roces. Buenos Aires: Santiago Rueda, 1949:311–328 (original German edition 1903).
43. The literature on the philosophical and psychological nature of ‘concepts’is enormous. This should not dissuade wouldbe classificators from undertaking the arduous task of learning about them (see: Mechelen et al. (1993), ibid; Fodor (1988), ibid; Peacocke C. A study of concepts. Cambridge: MITPress, 1998; Palmer A. Concept and object. London: Routledge, 1988; Weitz M. Theories of concepts: a history of the major philosophical tradition. London: Routledge 1988; Rickert H. The limits of concept formation in natural science. Cambridge: Cambridge University Press, 1986; first published in 1902).
44. Prototypes (see: Rosch E. Principles of categorization. In: Rosch E, Lloyd B, eds. Cognition and categorization. Hillsdate, NJ:Erlbaum, 1978:27–47) in the field of psychiatry have also been called ‘ideal types’(see: Schartz MA, Wiggins OP. Diagnosis and ideal types: a contribution to psychiatric classification. Comprehensive Psychiatry 1987; 28:277–291); and ‘hypothetical construct’(see: Morey LC. Classification of mental disorder as a collection of hypothetical constructs. Journal of Abnormal Psychology 1991; 100:289–293).
45. Hampton J. Prototype models of concept representation. In: Van Mechelen et al., eds 1993, ibid. 1993:70.
46. See Mill JS (1898) ibid.
47. p.685, Hale B, Wright C. A companion to the philosophy of language. Oxford: Blackwell, 1997.
48. p.xi, Durkheim and Mauss (1963) ibid.
49. p.4, Estes WK (1994) ibid.
50. Markman AB, Yamauchi T, Makin VS. The creation of new concepts: a multifaceted approach to category learning. In: Ward TB, Smith SM, Vaid J, eds Creative thought. An inves tigation of conceptual structures and processes. Washington DC: American Psychological Association, 1997:179–208.
51. Foucault (1966) ibid.
52. Rousseau N. Connaissance et langage chez Condillac. Geneva: Droz, 1986.
53. Speziale P. Classification of the sciences. In: Wiener PP, ed. Dictionary of the history of ideas, Vol 1. New York: Charles Scribner's Sons, 1973:462–467.
54. Pinel requires no introduction. See: Riese W. The legacy of Philipe Pinel. New York: Springer, 1969; Postel J. Genése de la Psychiatrie. Paris: Le Sycomore, 1981; Garrabé J, ed. Philipe Pinel. Paris: Les Empêcheurs de Penser en Rond, 1994.
55. W. Cullen (1710–1790): born in Scotland, trained in Glasgow, and eventually professor at Edinburgh, Cullen was one of the most important clinicians, classificators and medical philosophers of the 18th century. His emphasis on the role of the central nervous system in the development of all diseases led to his neural-pathology hypothesis. His concept of ‘neurosis’(word he coined) is therefore over-inclusive and caused much difficulty during the following century.
56. Pinel (1813) ibid.
57. p.xxiii Bouillaud J. Traité de nosographie médicale. 5Vols. Paris: Baillière, 1846.
58. p.xcii, Bouillaud (1846) ibid.
59. Riese W. History and principles of classification of nervous diseases. Bulletin of the History of Medicine 1945; 25:465–512.
60. This is by far the most popular method and most historical accounts of classification consist of chronological lists: a good illustration is Menninger (1964) ibid; or Faber K. Nosography in modern medicine. London: Oxford University Press, 1923.
61. According to this approach, medical classifications would be a super-structure, epiphenomenon, or reflection of deep social and economic structures, and hence would tell more about the social frames, people and times when they appeared than about the biology of disease. Although there are excellent social histories of psychiatry, rather surprisingly, no good social history of psychiatric classifications has yet been written.
62. Lanteri-Laura G. Classification et Sémiologie. Confrontations Psychiatriques 1984; 24:57–77.
63. p.638, in Desruelles et al. (1934) ibid.
64. Surprisingly, it is not mentioned in Pichot PJ. The French approach to psychiatric classification. British Journal of Psychiatry 1984; 144:113–118.
65. See López Piñero (1983) ibid.
66. It is often not mentioned that even great men such as Kraepelin and Chaslin went through nationalistic periods and gratuitously attacked psychiatric developments in the rival countries. For example, Kraepelin was a Bismarkian à outrance and even wrote a paper comparing his own personality to Bismark's! (see: Kraepelin E. Bismarck's Persönlichkeit. Ungedruckte persönliche Erinnerungen. Süddetische Monatshefte 1921; 19:105–122). Likewise, Chaslin attacked the use of German nosological categories in France and enjoined his fellow country men to develop their own nosology (see: Berrios GE, Fuentenebro F. Introduction to, and translation of, Chaslin's ‘Is psychiatry a well-made language?’ History of Psychiatry 1995; 6:387–406). But there were also objective efforts to compare French and German psychiatric classifications. A superb example is Roubinovitch J. Des variétés cliniques de la folie en France et en Allemagne. Paris: Doin, 1896.
67. Phillipe Buchez (1796–1866) physician, publicist and social reformer, for a time associated with the Carbonari and the Saint-Simoniens, he eventually developed a form of Christian socialism on which he lectured widely. He wrote on history, psychology and psychiatry. His parliamentary career came to an abrupt halt in 1848 when as President of the Constituent Assembly he showed much indecisiveness vis-à-vis the disorderly conduct of those who protested in favour of Poland (see: Biéder J. Un précurseur de la démocratie chrétienne et de l'Europe à la Société Médico-Psychologique: Phillipe-Joseph-Benjamin Buchez. Annales Médico-Psychologiques 1986; 144:109–115; and Robaux (no initial). La vie de Buchez. Annales de Thérapeutique Psychiatrique 1965; 4:220–234.
68. Quoted in Desruelles et al. (1934) ibid.
69. p.328 Buchez P. Reports, Annales Médico-Psychologique 1861; 7:326–330
70. Féré, Traité de Pathologie Générale (quoted in p.41, Desruelles M. Les Classifications des Maladies Mentales dans l'Enseignement Contemporain. Annales Médico-Psychologiques 1934; 92:41–58.
71. Baillarger, quoted in Desruelles et al. (1934) ibid.
72. The debates of the Société Médico Psychologique are famous for they brought together the great alienists of the day and on occasions led to some conclusions. Topics such as Hallucinations and Classifications were debated more than once.
73. Louis Jean Françoise Delasiauve (1804–1893) was a physician with political and literary interests turned alienist. He researched and wrote widely on epilepsy, mental retardation and education.
74. Bénédict-Augustin Morel (1809–1873) is well known to Anglo-Saxon psychiatrists for his writings on degeneration and démence précoce. However, his output and interests were much wider. Morel and Buchez were close friends. Morel attacked all psychiatric classifications based on symptoms and surface phenomena and proposed instead an ‘aetiological’criterion. Buchez's favourable review appeared as ‘Rapport sur le Traité des Maladies Mentales de M. Morel. Annales Médico-Psychologiques 1860; 6:613–635. Morel's classification included six (purportedly aetiological) groups: ‘1) Hereditary insanity, 2) Toxic insanity, 3) Insanity produced by the transformations of other diseases, 4) Ideopathic insanity, 5) Sympathetic insanity, 6) Dementia’. (pp.258–272, Morel BA. Traité des Maladies Mentales. Paris: Masson, 1860.
75. p.131, Reports. Séance of 12 November 1860, in 1861, Annales Médico-Psychologiques 1861; 7:128–143.
76. p.143, Reports, 1861, ibid
77. Jules Falret (1824–1902), son of the alienist Jean Pierre Falret (1794–1870) was a bright and shy academic who grew in the shadow of his authoritarian father.A friend of Lasègue and Morel, he researched into general paralysis of the insane, delusions, epilepsy and folie a deux.
78. p.147, Reports, 1861, ibid.
79. However, see Fava GA, Kellner R. Staging: a neglected dimension in psychiatric classification. Acta Psychiatrica Scandinavica 1993; 87:225–230.
80. p.148, Reports, 1861, ibid.
81. p.171, Reports, 1861, ibid.
82. p.176, Reports, 1861, ibid.
83. Adolphe Garnier (1802–1864), distinguished philosopher of mind, died (it is said of grief after the death of his only son) four years after his intervention at the SMPmeeting. Trained under Jouffroy, Garnier wrote a thesis on Thomas Reid and can be considered as one of main expositors in France of the Scottish philosophy of common sense. A defender of a version of faculty psychology (this is analysed in a crystal-clear fashion in his La Psychologie et la Phénologie Comparées. Paris: Hachette, 1839), Garnier proposed a new classification of the mental faculties in his superb Traité des Facultés de l'ame (Paris: Hachette, 1852). His intervention in the SMPdebate is thus important for it first underlies the interdisciplinary nature of the SMPat the time, and second, the fact that he was able to bring into the debate the central tenets of French philosophy of mind: a combination of faculty psychology and spiritualist eclecticism (for an account of Garnier's philosophy see Charles, É. Garnier. In: Franck A, ed. Dictionnaire des Sciences Philosophiques. 2nd Ed. Paris: Hachette, 1875:593–594.
84. Alfred Maury (1817–1892) was a polymath who trained in mathematics, the law, archaeology and medicine and through his friendship with Baillarger and Moreau de Tours became interested in psychological medicine. A Republican, he took an anti-Catholic stance and argued always in favour of an organicist approach to mental illness (on Maury himself see: Bowman FP. Du romanticisme au positivisme: Alfred Maury Romanticisme (no volume) 1978:21–22; 35–53). In the famous debate on the nature of hallucinations (particularly as experienced by some Roman Catholic saints, Pascal and Socrates) he was on the side of Lélut in believing that these experiences were the result of a disease of the brain (see his Des hallucinations. Paris: Paris, Bourgogne and Martinet; 1845; for an account of the hallucination debate see: Dowbiggin I. Alfred Maury and the politics of the unconscious in nineteenth century France. History of Psychiatry 1990; 1:255–287; James T. Dream, creativity and madness in nineteenth century France. Oxford: Clarendon Press, 1995). It is difficult to imagine a wider ideological gap than that separating Maury and Garnier. Hence their debate on psychiatric classification on 10 December 1860 is particularly important.
85. pp.316–320, Report, 1861, ibid.
86. pp.320–322, Report, 1861, ibid.
87. Francis Bacon (1561–1626): Cambridge-trained English statesman and philosopher of science whose work under-went a revival during the 19th century. Bacon's principles are contained in the Instauratio Magna (Great Instauration), his grand plan to help man to regain control upon the natural world: a classification of the sciences; new principles to interpret nature (Novum Organon); a guide and catalogue of the phenomena of the universe, i.e. a veritable corpus of empirical data and research methodologies; the Ladder of the intellect; anticipations of the new philosophy; and the new philosophy or active science (see p.248, in: The philosophical works of Francis Bacon. Ed. John M. Robertson. London: George Routledge and Sons, 1905).) For a study of Bacon's classification methodology see: Chapter 1, 2 and 3 of Peltonen M, ed. The Cambridge com panion to Bacon. Cambridge: Cambridge University Press, 1996. Bacon tried to persuade James I to found ‘science’ chairs at Oxford and Cambridge. His advice went unheeded in his lifetime but there is agreement among historians that the later foundation by Charles II of the Royal Society is a late reflection of Baconianism.
88. pp.323–326, Reports, 1861, ibid.
89. p.325, Reports, 1861, ibid.
90. This concept is currently discussed as the ‘unitary psy-chosis’hypothesis (see: Berrios GE, Beer D. The notion of unitary psychosis: a conceptual history. History of Psychiatry 1994; 5:13–36).
91. Buchez was here criticising remnants in the 19th century of the old ‘ontological’model of disease (see: Riese W. The conception of disease. Its history, its versions and its nature. New York: Philosophical Library, 1991; also Vié J. Sur l'existence d'entités morbides en psychiatrie, l'utilité et l'orientation de l'effort nosologique. Annales Médico-Psychologiques 1940; 98:347–358).
92. pp.326–330, Reports, 1861, ibid.
93. pp.330–332, Reports, 1861, ibid.
94. Théophile Archambault (1806–1863) was then a senior alienist and secretary general of the SMP. He died within two years of this intervention. He was a disciple of Esquirol and knew English well. In 1840, he translated Ellis's ‘Treatise on the Nature, Causes, Symptoms and Treatment of Insanity’(1838) into French. He did classical work on urinary incontinence in the insane.
95. p.332, Reports, 1861, ibid.
96. p.648, Desruelles et al. 1934, ibid.
97. There is no space in this paper to even touch upon this important debate (which stretched from the meeting of July 1888 to that of June 1889 [Annales Médico-Psychologiques]) where a new generation of French psychiatrists had a second go at the problem. Aconceptual analysis of this debate and a comparison with the 1860–1861 debate must be part of any future history of psychiatric classifications.
98. p.233, Tuke DH. Classifications. In: Tuke DH. (ed) Dictionary of psychological medicine 2Vols. London: Churchill, 1882:229–233.
