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Who was Emil Kraepelin and why do we remember him 160 years later?

Usually, Emil Wilhelm Magnus Georg Kraepelin (1856-1926) is identified as the founder of modern scientific psychiatry (Decker 2004, Engstrom & Kendler 2015, Healy, Harris, Farquhar, Tschinkel, & Le Noury 2008, Hippius & Mueller 2008, Hoff 1994, Jablensky, Hugler, Voncranach, & Kalinov 1993, Steinberg 2015). However, it took some time to recognize Kraepelin's other contributions to many other areas such as psychopharmacology (Muller, Fletcher, & Steinberg 2006, Saarma & Vahing 1976, Schmied, Steinberg, & Sykes 2006, Vahing & Mehilane 1990), sleep research (Becker, Steinberg, & Kluge 2016) and psychology (Eysenck & Frith 1977, Steinberg 2015).

Although Kraepelin was born 160 years ago, his works have still been cited with a frequency, which makes him one of the most influential psychiatrists of all times. He was only 30 years old when he delivered his inaugural speech Die Richtungen der psychiatrischen Forschung On different approaches/schools in psychiatric research/ in the Assembly Hall (Aula) of the University of Dorpat, nowadays known as the University of Tartu, Estonia. In order to commemorate Kraepelin's 160th birthdate and the 130th year from his first professorship, a conference "Emil Kraepelin 160/130" was held in the same Aula where 130 years earlier Kraepelin expressed his views about explanations of psychiatric illnesses (Engstrom & Kendler 2015). The conference was organized jointly by the Institute of Psychology and the Faculty of Medicine, University of Tartu and the Estonian Academy of Sciences. The organizing committee consisted of Juri Allik, Erki Tammiksaar, Urmas Varblane, Toomas Asser, and Kirsti Akkermann. The following talks were presented on February 19, 2016:

Wolfgang Drechsler (Tallinn University of Technology) "Opening words"

Eric J. Engstrom (Humboldt University of Berlin) "Emil Kraepelin's Inaugural Lecture: Contexts and Legacies"

Juri Allik (University of Tartu) "Emil Kraepelin and the emergence of experimental psychology"

Frank Gruner and Maike Rotzoll (University of Heidelberg) "The University of Dorpat as a Transit Space for Psychiatric Knowledge? Emil Kraepelin and the Concept of Melancholy"

Erki Tammiksaar (University of Tartu) "University of Dorpat at the time of Emil Kraepelin"

Nils Hansson (University of Cologne) "The godfather of European psychiatry and no prize: Tracing Emil Kraepelin in the Nobel Prize archive"

Ken Kalling (University of Tartu) "Emil Kraepelin's successor Prof. V. Chizh and criminal anthropology at the University of Dorpat".

This special issue is composed of talks that were held at the conference "Emil Kraepelin 160/130." However, the papers in this special issue are in most cases much more elaborated versions of the presented talks. One reason for the progress were stimulating discussions between participants during and after the conference.

In this introduction, we remember some basic facts about Emil Kraepelin's life and the impact he made in various areas, not only in psychiatry. We also try to create a context into which papers presented in this special issue of Trames can be placed.

Biographical facts

Emil Kraepelin (also Krapelin) was born on the 15th of February 1856 in Neusterlitz, which belonged to the Duchy of Mecklenburg-Strelitz at the time. Thus, in the year 2016 we are celebrating his 160th birthday to say nothing about 90 years from his death. His father, Karl Wilhelm (1817-1882), was a former opera singer and, later, a music teacher. He also had a brother Karl (1848-1915) who was 10 years older and who became the director of the Zoological Museum of Hamburg.

After completing the local high school, Kraepelin began his medical studies at the Leipzig University in 1874. Under the guidance of Paul Flechsig (1847-1929) and Wilhelm Wundt (1832-1920) he studied neuropathology but also experimental psychology even before it was recognized as an independent discipline of science. Every psychology student knows that the first Laboratory of Experimental Psychology was established by Wilhelm Wundt in Leipzig in 1879, which is regarded as the birth of scientific psychology (Bringmann, Voss, & Ungerer 1997). Wundt became a mentor for Kraepelin with whom he discussed all-important decisions in his life. While studying in Leipzig, Kraepelin wrote a prizewinning essay, "The Influence of Acute Illness in the Causation of Mental Disorders."

Kraepelin completed his medical studies at the University of Wurzburg (1877-1878). At Wurzburg he passed his Rigorosum in March 1878, his Staatsexamen in July 1878, and his Approbation on 9 August 1878. Franz von Rinecker (1811-1883) offered Kraepelin a job as medical assistant in his clinic in 1877. However, his first impressions from the psychiatric clinic were not very encouraging:

"At the beginning, work on the ward upset me very much. /.../ The intensity of unusual, disturbing impressions and the first feeling of personal responsibility pursued me into my sleep and caused irritating dreams. Therefore, after about 14 days at the clinic I told Rinecker that I would probably not be able to stand the work for any length of time. He only smiled and said that many other assistant doctors had had similar problems, I would soon get used to it. In actual fact, I overcome my accustomization difficulties after a few weeks" (Kraepelin 1987:7).

Kraepelin then enrolled at the University of Munich for his doctoral studies in 1879. With Bernhard von Gudden (1824-1886) as his doctoral supervisor, Kraepelin completed his Habilitation with a thesis "The Place of Psychology in Psychiatry" at Leipzig. On December 3 1883 he completed his Umhabilitierung at Munich.

In 1882, Emil began work in the field of psychopharmacology at Wilhelm Wundt's laboratory at Leipzig University. He was also involved in the study of neurology under neurologist Wilhelm Heinrich Erb (1840-1921).

In the same year 1883, 27-years-old Kraepelin published the first version of what would be his life work, Compendium der Psychiatrie: Zum Gebrauche fur Studierende und Aerzte / Compendium of Psychiatry: For the Use of Students and Physicians/. Later it was transformed into Ein Lehrbuch der Psychiatrie / A Textbook of Psychiatry/ with the 9th edition already one year after his death in 1926. The last edition of his Lehrbuch had 2,425 pages, which is about ten times larger of his first Compendium.

In 1884 he became senior physician in the Prussian provincial town of Leubus, Silesia. In the same year, Kraepelin married Ina Schwabe (1855-1944). They had eight children: Marie (1885-1885), Antonie (1887-1962), Vera (1888-1890), Hans (1890-1891), Eva (1892-1983), Ina (1894-1959), Hanna (1896-1972), and Ernst (1900-1900).

The University of Dorpat (1) in the Russian Empire appointed him as a professor in 1886 and during the professorship he was eventually promoted as the director of the healthcare and medical education institute affiliated to the university. It was in Dorpat that Emil elaborated his work on classifying mental disorders, which was started in the Compendium.

Kraepelin left Dorpat in 1891 becoming the head of the Department of Psychiatry at the University of Heidelberg for the next fourteen years.

During the period 1903-1922, he worked as a professor at the University of Munich. When the German Society of Psychiatry approached him, he pioneered in establishing the research centre--Deutsche Forschungsanstalt fur Psychiatrie /The German Institute for Psychiatric Research/ and supervised the entire process until the institution was established in 1917.

In 1922 Kraepelin retired from academic positions.

After a short illness Kraepelin died in Munich on October 7 1926. At the time of his death, he was working on the 9th edition of his textbook on psychiatry that was published the following year.

A good addition to his academic work is Memoirs written during or immediately after World War I. It provides a good panorama of his intellectual world. He seems to have had a lot of free time during that period, as eight scientific articles were published (Kraepelin 1987:236). Why Memoirs was not published immediately after writing and appeared only in 1983, is not known. Memoirs were translated into English in 1987 (Kraepelin 1987). He also wrote what is known as his 'Self-Assessment' soon after World War I. Like Memoirs, it remained unpublished after Kraepelin's death. Eric Engstrom with colleagues described and published this manuscript in English (Engstrom, Burgmair, & Weber 2002, Kraepelin 2002).

Unlike many of his academic colleagues (e.g. Wilhelm Ostwald 1853-1932, working in Dorpat in 1877-1881 and then, in 1887, going to Leipzig to receive the Nobel Prize in 1909), Kraepelin's ambitions were not connected with politics (Kraepelin 1987:167). Nevertheless, several social problems of scientific context, which were topical in Europe, were very important to him, too. One of such topics was the struggle with alcoholism, which he began to deal with in Dorpat. This special issue of Trames does not contain any articles devoted to that topic. However, Kraepelin was one of the first who supported the temperance movement based on scientific knowledge which since the 1880s, thanks to Gustav von Bunge (1844-1920), born in Dorpat, increasingly gained support in Europe (Blocher 1920, Graeter 1952, Schmidt 1972, Kalling, Tammiksaar 2015). Although Bunge left Dorpat in 1885, shortly before Kraepelin arrived there, it is known that Kraepelin's interest in that kind of problems increased in Dorpat (Kraepelin 1987:70). Perhaps it was the famous inauguration lecture entitled Die Alkoholfrage (Bunge 1887) performed by Bunge in Basel University in 1886 that served as an impact on that. As follows from the memories of the close colleague of Kraepelin in his Leipzig period (Kraepelin 1987:24), the Baltic German Adolf Strumpell (2) (1925:53), the mental heritage of Bunge was perceptible within the Dorpat University even after he had left the town and his anti-alcohol activities were widely discussed (Kalling, Tammiksaar 2015). The first anti-alcohol study, however, was published by Kraepelin only at the end of the 19th century (Kraepelin 1899). Since the beginning of the 20th century, his regular studies on the damage of alcohol on the mental health of a person appeared, several of them were published in the proceedings of the Basel temperance society founded by Bunge (Kraepelin 1987:234-238). As a result, these two abstainers began to communicate with each other (Kraepelin 1987: 71).

Against the background of views that are acceptable today, Kraepelin was not enlightened in every aspect of the modern life. For example, acknowledging women's rights, he nevertheless issued a warning:

"At the same time, I have always believed that the most valuable and indispensable characteristics of the female sex would be seriously endangered if women were rigorously incorporated into the bustle of the working world" (Kraepelin 2002:107).

Like many of his colleagues, he was obviously an anti-Semite. In the 'Self-Assessment' he wrote:

"I also regarded the growing danger that Judaism posed to the future of our folk as a matter of great concern. On a number of occasions, the Semitic race has demonstrated a tendency to forge ahead for the sake of superficial advantage rather than for inner gratification. /.../1 noted with concern that the influence wielded by Jews in the science far outweighed the proportion they represent of the population, this was disastrous, because once again the ambition for success and recognition took precedence over the search for truth and knowledge. Although I entertained personal relations with numerous Jews, and held some in great esteem, I could only regard them as the salt of the earth, which perhaps was necessary for the development of our own abilities. Any dominant influence of the Jewish spirit on German science, such as sadly came to be increasingly evident, seemed to me to pose a very grave danger indeed--a danger that needed to be countered primarily by the systematic promotion of outstanding talent within the German race" (Kraepelin 2002:108).

We agree completely with Engstrom and colleagues that in his 'Self-Assessment' Kraepelin turned his diagnostic methods on himself and clinically documented his own state of mind (Engstrom et al. 2002). His state of mind, however, reflected the transformation and radicalization of anti-Semitism in Germany after 1918. After the war, it became significantly more virulent, manifesting itself in the wider context of anti-modern protest and resentment (p. 97). Although Tartu/Dorpat served as a refuge for many nationalities, it should not be forgotten that universities in the Russian Empire introduced quotas for Jews already at that time.

Kraepelin in Dorpat

Details of how Kraepelin was invited to Dorpat we know mainly from an excellent article by Steinberg and Angermeyer (2001) and a special monograph devoted to this period of Kraepelin's life (Kraepelin, Burgmair, Engstrom, Hirschmuller, & Weber 2003).

We start this short overview from a notice that the University Hospital of Psychiatry for 50 patients was opened on 16th of April 1881 with an agreement to open a chair of psychiatry at the university. The first professor to be appointed was Hermann Emminghaus (1845-1904) who was also the head of the Hospital. He studied medicine at the Universities of Gottingen and Jena, obtaining his medical doctorate in 1869. He was invited to Dorpat in 1880 and left for Freiburg in 1886 where the new chair of psychiatry was established. From the very start, he banned any kind of restraint on his patients and introduced modem forms of treatment such as work therapy. Besides his administrative skills, Emminghaus was an outstanding psychiatrist who is regarded as one of pioneers of child and developmental psychiatry. At Dorpat he continued to collect materials for his monograph on mental disorders in children and adolescents, Die psychischen Storungen des Kindesalters/The mental disorders of children from Baltic provinces/, which appeared in Gerhardt's Handbook of Children's Diseases (Steinberg & Angermeyer 2001, pp. 298-299).

Initially, the council of the Medical Faculty compiled a list of candidates to appoint as Emminghaus' successor. These candidates were Kirn (Freiburg), Kraepelin (Dresden), Moeli (Berlin), and Mercklin (Riga) (Steinberg, Angermeyer 2001:299). However, after a consideration Kraepelin was selected as the only candidate to whom the proposal was sent. It is most likely that Emminghaus strongly recommended the faculty council to elect Kraepelin as his successor because Kraepelin worked in Wurzburg under Emminghaus. It seems that Emminghaus was impressed by Kraepelin and it was not very difficult for him to support a young talented colleague. Kraepelin apparently learned about his appointment from a letter sent by Emminghaus.

According to archival data, letters of recommendation were from Wilhelm Wundt, the Strassburg psychiatrist Friedrich Jolly and Emminghaus. It was recognized that Kraepelin was not only very much at home in clinical matters but also broadly experienced in the fields of experimental psychology, as well as with electro-therapeutics and nervous disorders. It was also mentioned that to compensate for lack of psychiatric observation material he followed von Gudden's request to return to the county asylum in Munich. He was also able to conduct well-attended lectures (Steinberg & Angermeyer 2001, p. 300).

In his Memoirs, Kraepelin also devoted a considerable space, about 22 pages out of 219, to his work and life in Dorpat (Kraepelin 1987). A portrait of Emil Kraepelin taken by Carl Schulz, a photographer of Dorpat, is shown in Figure 1.

In his inaugural lecture, young Kraepelin refused to accept the dominant concept that brain mechanisms are sufficient to describe any mental disorder. Because the majority of these mechanisms were unknown and even unreachable by the tools that psychiatry possessed in these days, the researchers had to invent their own 'brain mythology.' Eric Engstrom in his paper "Emil Kraepelin's Inaugural Lecture in Dorpat: Contexts and Legacies" (Engstrom 2016) describes how thirty-year-old Kraepelin had a courage to oppose himself to the 'brain mythology' orthodoxy.

Perhaps it is not a coincidence that another young doctor Sigmund Freud (1856-1939) was writing only some 8 years later a memorandum, which is known as Entwurf einer Psychologie (usually translated into English as the Project for a scientific psychology). In this paper, which was published only in 1950, Freud adopted 'brain mythology' supported by Wilhelm Griesinger (1817-1868) and Theodor Meynert (1833-1892) who was one of Freud's teachers. However, it is argued that although Freud later abandoned invoking hypothetical brain mechanisms for the explanation hysteria or dream mechanisms, he still remained, in Frank Sulloway's words, a 'crypto-biologist' (Sulloway 1992) who thought in terms of fictional brain mechanisms.

However, the reception of one of Wundt's best students was not universally enthusiastic by Kraepelin's Dorpat colleagues. The idea to use experimental psychology in psychiatric, to say nothing about psychological, research did not make everyone happy. One of Wundt's most vocal antagonist philosophers Gustav Teichmuller (1832-1888) occupied the Chair of Philosophy in Dorpat. Teichmuller is probably one of the most original and internationally known philosophers who have ever worked or lived here. Teichmuller is known as a founder of the school of personalism, where the main statement is that only a person's self-consciousness is a unique window through which the world can be experienced. It is expected that Teichmuller regarded Wundt's attempts to apply experimental methods for the study of human psychology as completely meaningless and misleading. It is difficult to see how Teichmuller could intervene with what was Kraepelin teaching or studying, but Wundt was reacting empathically in their private correspondence to how Kraepelin described his situation in Dorpat:

"Recently I read the preface to 'Philosophy of Religion' by your colleague Teichmuller. I thought I could skip the rest afterwards. I would deem it undeservedly suspicious to be treated by this man, who calls Springer [probably a mistake instead of Spinoza] a mental cripple, except with swear-words. Generally speaking this philosopher's declamation rather give the impression that he will be ready for your asylum in the near future" (Steinberg & Angermeyer 2001, p. 304).

Nevertheless, Kraepelin was apparently satisfied with his professional life in Dorpat. There were colleagues who welcomed him and there was never a shortage of students who attended his lectures or were willing to spend time on research:

"The conditions for starting a school of psychology in Dorpat were favourable. /.../ Luckily, I found a lot of keen, self-sacrificing students prepared to devote many, many months' work solely to their doctoral theses" (Kraepelin 1987:4445).

He also found the general scientific life in Dorpat stimulating, as there were always a number of younger professors present, who worked with enthusiasm (46). The general academic atmosphere in Dorpat pleased Kraepelin with its egalitarianism:

"With the university so close at hand, the university members had active contact with one another. One often came in touch with others, got to know one another better and had more or less lively social life. As the difference in rank according to seniority in office were not expressed in terms of titled and were completely neglected and there was no courtly influence whatsoever an atmosphere of unconditional equality reigned, which had a very favourable influence on mutual relation relationship" (Kraepelin 1987:47).

Kraepelin stood in the opposition to a powerful group of Baltic Germans who were headed by the family von Oettingen (48). This conservative group favoured filling every vacant academic position with local Baltic Germans avoiding the appointment of the State-Germans (Reich-Deutsch) at all costs. Russification was a useful tool in favouring Baltic Germans over the mainlanders because the former usually spoke Russian sufficiently well. Nevertheless, Kraepelin seemed to be rather popular among students:

"A gradual shift in the situation occurred with the approaching and finally strongly established Russianization of the university. By this time, the Baltics [local Germans] realized that the large number of German professors at the university could help to put a stop to this fate. On the other hand, a number of German colleagues increasingly took sides with the Russian government and was used by the government to undermine the resistance of the university against the measures ordained. The struggles between these opposing factors intensified considerably, until finally the university lost its right to appoint positions, thus sealing its downfall. /.../ I stood in bad repute with the government and their rector [Ottomar Meykow]. /.../ On my departure, the students on my side wanted to make a torch procession for me. The rector did all in his power to hinder it, but the prorector, Alexander Brueckner [18341896], the historian, had police control over the students, gave his permission for the procession and took over the responsibility. The torch procession took place" (Kraepelin 1987:49).

Because Kraepelin considered professorial chairs in Heidelberg or Munich the most desired goals of his academic career, he commented about his departure from Dorpat in the following words:

"I left Dorpat light-heartedly in 1891 at the end of March" (Kraepelin 1987:57).

Returning to the initial years in Dorpat, Kraepelin founded the Dorpat Psychological Society in 1887, which soon had 14 members, mostly physicians (Steinberg & Angermeyer 2001, p. 305). He also established the first laboratory of experimental psychology, not only in the region but also in the entire Russian Empire. He asked Alexander Schmidt (1831-1894)3, Professor of Physiology and the Rector of the university at that time to provide rooms for this venture. Fortunately, a new building was just finished for the Department of Physiology headed by Schmidt who was able to find a room for the Kraepelin's laboratory (Ramul 1974, Steinberg & Angermeyer 2001, p. 305). Thus, it is certain that from the beginning of 1888 at the latest the scientific psychology arrived in Estonia. By a coincidence, the Department of Psychology moved into the same building (Naituse 2 or New Anatomicum) where the first laboratory of psychology was established in 2014 (see Figure 2).

It seems to be a dominant view that Kraepelin was a great psychiatrist but he did very little if anything significant for psychology. This seems to be a misconception because Juri Allik demonstrates in his paper "Why was Emil Kraepelin not recognized as a psychologist?" (this issue) that Kraepelin was also a great psychologist.

A bibliometric sketch

For the evaluation of Kraepelin's contribution to modern science, we carried out a small bibliometric analysis. The Google Scholar is probably the largest search engine for scholarly literature. It searches for a wide range of scholarly publications from academic journals to online repositories, universities and other web sites. Publish or Perish (PoP) is a software program, which was created by Anne-Wil Harzing to retrieve and analyse academic citations. It uses Google Scholar and Microsoft Academic Search as a source in obtaining citation data for authors whose names can be uniquely identified.

A search (October 26 2016) with the search line E. Kraepelin identified more than 700 publications (including translations and various editions) which were cited 17,566 times. The h-index was equal to 40. Thus, from the first Kraepelin's publication about 135 years ago his books and papers have been cited on average 130 times each year. Interestingly, the most cited book is the English translation of his Dementia praecox and paraphrenia (1971), which has been cited 3,473 times. Various editions and translations of Kraepelin's Psychiatrie or Lehrbuch have been cited altogether several thousand times.

In summary, although it is already 90 years from Kraepelin's death, his ideas are very much alive and cited by modern researchers.

Thus, it is not surprising that Kraepelin was nominated for the Nobel Prize for his contribution to psychiatry on at least eight occasions from 1909 to 1926. Nils Hansson, Thorsten Hailing, and Heiner Fangerau in their paper "Emil Kraepelin's Nobelibility" (this issue) discuss why the prize eluded Kraepelin and what it could mean to be prize-worthy in general and in psychiatry in particular.

Speaking and understanding Estonian

It is difficult or impossible to judge how well Kraepelin spoke or understood Estonian. The majority of his patients in Dorpat/Tartu spoke only Estonian or Russian. According to his Memoirs, he made an effort to study both Estonian and Russian but soon understood that the cause is not worth the effort to achieve it. In his Memoirs he wrote: "I tried to learn Russian and Estonian more thoroughly, but gave it up, when I realized that the success achieved was not in proportion to the time and effort necessary" (Kraepelin 1987, p. 40). Kraepelin could address his mostly Estonian- and Russian-speaking patients only with the help of an interpreter (Steinberg & Angermeyer 2001, p. 302):

"It was very laborious for me to work with the patients, because I had difficulties with the language. The majority of patients suitable for teaching purposes only understood Estonian. There were also some individual patients, who spoke Russian or Latvian. Therefore, I was not able to communicate with most of the patients without constant translation, although I gradually learn the most common questions and requests, unfortunately, the patients did not always keep to my limited vocabulary in their answers" (Kraepelin 1987:40).

In his so-called "Self-assessment", Kraepelin admitted that mastering languages, especially in written form, was never difficult for him. He also confessed that he was able to understand both Russian and Estonian to a certain extent (Engstrom et al. 2002, p. 101). At least once, he was able to demonstrate his skills in Estonian. Perhaps in one of the funniest parts of his Memoirs, he wrote how he visited an asylum in Constantinople, which was run by French nurses. As an example of particularly complicated cases, he was shown a patient who spoke a language nobody could understand. We can only imagine the amazement of all participants when their distinguished guest suddenly started to talk to this patient in his mother tongue:

"I was shown a man, whose origin was unclear, as he spoke a completely unknown language. To my surprise, I realized that he spoke Estonian, of course, he was pleased to finally find someone, who could speak at least few words of his mother tongue with him" (Kraepelin 1987:82).

Perhaps Hemingway's misquote that "In every port in the world, at least two Estonians can be found" is not so wrong after all. (4)

Cross-cultural psychiatry

As a psychiatrist, Kraepelin was in a strange situation. To say nothing about asylum, which required reforms, he mostly confronted patients whose speech remained largely unintelligible to him. At least sometimes he might felt like an anthropologist from Mars. Nevertheless, it was Kraepelin who founded the comparative psychiatry in the search of cross-cultural similarities and differences in the expression of mental disorders (Jilek 1995, Machleidt & Sieberer 2013). Kraepelin inquired and analysed clinical data from the asylum at Buitenzorg (Bogor) on the major Indonesian island of Java finding that dementia praecox and other mental disturbances were occurring with approximately the same frequency as in European countries (Kraepelin 1904). In his Memoirs Kraepelin wrote about his Java observations:

"A hasty examination showed that most of the patient population had [no] dementia praecox to a greater extent than in Germany and that therefore race, climate and living conditions had no decisive influence on the origin of this disease. /.../ The auditory hallucinations in case of dementia praecox are considered unimportant, probably because language and speech only have a lesser influence on the thinking process in Java. Delusions were also remarkably scarce. From these and other experiences, I became convinced that my attempt to prepare the way for comparative psychiatry could be successful and intended to follow-up these ideas as soon as possible" (Kraepelin 1987:115-116).

Thus, although Kraepelin observed approximately the same frequency of mental diseases in Java as in Germany, the symptoms of these diseases might have peculiarities influenced by race, climate or even culture.

Fascinatingly, Kraepelin started to talk about comparative psychiatry only after his visit to Java in 1904. In reality he had an opportunity to do it earlier when he arrived in Dorpat and encountered patients who did not speak any of the IndoEuropean languages. After travelling to Reval/Tallinn he made an excursion which gave him enough material for illuminating anthropological observations:

"This was the first time we were confronted with our new home surroundings, the little carts with the shaggy, brisk horses, the street names and shop signs in a foreign language, the rustic figures of Estonians, the Russian post-office, in which one was brusquely told to take off one's hat to the picture of a saint in the corner. The incredibly slow, sheer endless journey to Dorpat with long pauses at every small station gave us a good impression of the Russian railways " (Kraepelin 1987:36).

However, there is no information that he confronted something peculiar or noteworthy in mental disorders of his future patients who were mainly Estonians. Already before him, one of the greatest naturalists of the 19th century, Karl Ernst von Baer (1792-1876) observed in his doctoral dissertation On endemic diseases of Estonians (1814), which was defended in Dorpat many years before Kraepelin's arrival, that rustic Estonians suffer from diseases that are rare or unknown among Germans. At the same time, Baer spotted that, for instance, cramps and mental diseases are quite rare among Estonians. It remains a challenge to establish how Kraepelin's psychiatric experience in Dorpat influenced his later views on comparative psychiatry.

Clinic and patients

The clinic in Dorpat was the only mental asylum in the northern part of the Baltic provinces (Kraepelin 1987:37). The clinic was able to accommodate about 70-80 patients who sometimes came even from Lithuania after several days of journey (40). The clinic was, as Kraepelin proudly noted, the only place in Russia, where one could live without a passport (37).

Kraepelin described in details what he did to improve the financial situation, material conditions, and especially the reputation of the clinic (Kraepelin 1987: 37-43). Because it was a private institution, considerable efforts were needed to overcome prejudices against mental asylums in order to attract educated and wealthy patients. One welcomed category was colleagues from the university who were admitted for treatment of their nervous complaints (41).

The work of a medical scholar with his patients, providing a good picture of his practical merits, deserves as much interest as his academic research. The Russian writer Vikentij Veresaev has pointed out:

"As a younger student, I attended some two or three of his [Kraepelin's] clinical lectures, simply out of interest. There was a mentally ill patient present. Kraepelin started giving the patient questions, at the same time carefully watching him/her?, and there, at the same moment, with all of us present, the whole picture of the disease opened like a valuable piece of art. The final description, formulated by the professor, was a summary of all the questions given to the patient, which enabled the students to derive a logical and characteristic picture of the disease. Everything seemed so simple that even a strange question arose: what is so special in it?" (Veresaev 1961:339).

Although we know quite a lot about Kraepelin's Dorpat period, nobody has studied patient cards (Zahlkarte) that were introduced by Kraepelin and obviously played a pivotal role in his classification of mental disorders. These cards also provide information on diagnosing and treatment methods and about the wisdom of Kraepelin which Veresaev described.

Steinberg and Angermeyer write in their article about Kraepelin's period in Dorpat the following:

"Elmar-Johannes Karu (1903-1996) remembers that, during the Nazi occupation, the famous German psychiatrist Kurt Schneider (1887-1967) worked as military surgeon at Dorpat. He searched out patient files written by Kraepelin, and many of them can still be found in the Estonian National Archives" (Steinberg & Angermeyer 2001, p. 318).

In the Estonian National Archives, we do not find biographies of patients of the Psychiatric Clinic of Tartu University. Patient cards are preserved in the archives of the psychiatric clinic. Thus it is really praiseworthy that Maike Rotzoll and Frank Gruner in their paper "Emil Kraepelin and German Psychiatry in Multi-Cultural Dorpat/Tartu, 1886-1891" (this issue) have studied patient cards filled by Emminghaus and Kraepelin after so many years of their neglect and for the first time analyse their importance and the role of their assistant colleagues.

Academic and political situation

The time when Kraepelin arrived Dorpat in the late 1880s was mainly marked by the transition of the Russian Empire into a nation state (Kappeler 1992), which led to serious consequences for the Baltic Germans and for German higher education within what the Russians saw as simply another province of their country (Drechsler & Kattel 2000). Already in 1856, a year after Alexander II had ascended to the throne, a commission for the renewal of the statute of the University had been formed by the Ministry of Public Education. The new statute of the University was established in 1884, which marked the beginning of Russification. The reform in Dorpat was initially carried out under the leadership of the Curator--the representative of the government at a university--Georg Friedrich von Bradke (1796-1862), and from 1862 onwards, by his successor, Count Alexander Keyserling (1815-1891) (Drechsler & Kattel 2000). (5)

Keyserling's main concern, however, was the international level of Dorpat scholarship. In his letter to his friend Karl Ernst von Baer, Keyserling stressed that all connections with nationality must withdraw with an aim to change Dorpat an international university (Drechsler & Kattel 2000). There is no doubt that Kraepelin was on the side of those whose intention was to transform Dorpat into an excellent or German university, which were inseparable concepts at that time. However, many Baltic Germans perceived the support of Russification in their best interest even if it meant those who were not able or willing to teach in Russian.

Erki Tammiksaar gives a more elaborate picture about how political life in Dorpat looked like in his paper "Political atmosphere in Dorpat in Emil Kraepelin's period" (this issue).

Kraepelin's successor

For the development of psychology in Tartu, it was extremely fortunate that Kraepelin's successor was Vladimir Chizh (1955-1923) who was the first Russian member of the medical faculty. There are several important similarities between Chizh and his predecessor Kraepelin. They both completed medical training, they both studied psychology under Wilhelm Wundt in Leipzig, and during their professorship in Yur'ev, they supervised doctoral theses, which clearly belonged to psychology. Indeed, let us look only at the topics of these successfully defended dissertations (Ramul 1974):

* Memory of tactile sensations (Loewenton 1893),

* Memory of voluntary movements (Schneider 1894),

* Study of sensing location and memory of this sensation (Bart 1894),

* Memory of visual perception (Zaborowski 1894),

* Tactual and taste sensitivity among men and women from a different social background (Dehn 1894),

* Impact of stimuli with signalling value (Sokolowski 1898),

* Change of pulse and briefing during certain psychical states (Girs 1899),

* An experimental investigation of the tactual sense (Hildebrand 1899).

This list alone testifies that Chizh was continuing a series of experimental studies that were started earlier by Kraepelin.

Kraepelin and Chizh obviously shared interests in criminal anthropology and admiration towards one of its most remarkable founders, Cesare Lombroso (18361909). Ken Kalling tells us a fascinating story "Emil Kraepelin's successor prof. Vladimir Chizh, his research methods and objects" (this issue) about how Chizh tried to explain differences in the criminal behaviour of Estonians and Latvians in terms of their biological or racial differences.

Perhaps it is not a coincidence that Chizh was fascinated with what was called moral statistics. It is not surprising that scholars who disputed modernity and morality of society looked for suicide and criminal statistics. For example, Emile Durkheim is often credited with establishing the so-called "One Law of Sociology" or "Durkheim's Law": Protestants always kill themselves more often than Catholics (Lederer 2013). Like so many aspects of his research, that particular observation derives from the work of two Dorpat professors, in this case the moral statisticians Adolf Wagner (1835-1917) and his colleague Alexander von Oettingen (1827-1905). Alexander von Oettingen--two out of five of his brothers were also professors at the University of Dorpat--was professor of evangelical theology who published his prize-winning Moral Statistics in 1868 (Lederer 2013).

Interestingly, Kraepelin wrote a review essay about Lombroso's L'uomo delinquente (1884). Kraepelin's view of the theory that criminality is an atavistic characteristic was debatable in details, not in general. Criminality is caused, as Kraepelin seemed to agree with Lombroso, by biological, not social factors (Lees 2002, p. 151). It is unclear how much this concept is related to Kraepelin's views about mental disorders he so brilliantly discussed in his inaugural lecture in Dorpat. In spite of some inconsistencies, Chizh obviously believed in Lombroso's speculations much more faithfully than Kraepelin.

Kraepelin as a person

However, Kraepelin was not always a hero for all his colleagues. In the 1960s, there were several challenges to the mainstream psychiatry. One of these rebels was called anti-psychiatry because its representatives perceived the basic psychiatric practices developed by Kraepelin as repressive and dehumanizing. These dissidents perceived psychiatry as a coercive instrument of oppression, which emerged from an asymmetric power relation between doctor and patient. David Cooper coined the term 'anti-psychiatry' in 1967, which became popular after his book Psychiatry and Anti-Psychiatry was published (Cooper 1971). Thomas Szasz, another notable representative of the anti-establishment movement, introduced the definition of mental illness as a myth (Szasz 1962). Characteristically, Ronald Laing in his famous The Divided Self uses Kraepelin's technique of interviewing psychiatric patients as an example of the worst practices used by the mainstream psychiatry. Kraepelin is interested, Laing says, to get the 'useful information' out of the patient which is believed to be merely 'signs' of a 'disease':

"/.../ this patient's behaviour can be seen in at least two ways /.../ One may see his behaviour as 'signs' of a 'disease', one may see his behaviour as expression of his existence. The existential-phenomenological construction is an inference about the way the other is feeling and acting. What is the boy's experience of Kraepelin? He seems to be tormented and desperate. What is he 'about' in speaking and acting in this way? He is objecting to being measured and tested. He wants to be heard" (Laing 1960, pp. 30-31).

Ironically, these existential-phenomenological proclamations were mainly heard in departments of the humanities rather than in psychiatric wards or departments. Nevertheless, Kraepelin was often portrayed as a rational diagnostic machine without any compassion or empathy towards those whom he was sup posed to help. In Memoirs he used emotionally restrained prose, especially when he briefly talked about his personal tragedies, reinforced the impression that his humane qualities were seriously underdeveloped. However, it is important not to confuse the style of writing with actual feelings. In some rare cases, we can see behind a facade of restraint and self-discipline. For example, becoming a psychiatrist was not determined because Kraepelin's first impressions from the psychiatric clinic, as we mentioned above, were nightmarish (Kraepelin 1987:7).

Kraepelin was rather critical of his abilities. In his so-called 'Self-Assessment,' he assessed himself as rather slow in comprehension, limited in grasping day-today situations, and very poor in memorizing. He admitted that he never felt prompted to write poetry. Acquiring knowledge of history, as he wrote, required great effort but this knowledge disappeared with astonishing rapidity (Kraepelin 2002, pp. 98-101). From his passions, he mentioned love of travel (p. 103). Indeed, in his Memoirs he devoted to his journeys more space than to psychiatry and psychology rolled into one.

Kraepelin was obviously not very enlightened concerning politics and societal questions. He had no prior knowledge where Dorpat was and what it meant to live in the Russian Empire. He was a German patriot blaming the United Kingdom and other allies--Entente--of offending German rights for existence.

Summarizing what we currently know about Emil Kraepelin, it is necessary to agree with those critics who say that he had at least two faces (Shepherd 1995). In science, he was a reluctant revolutionary who attempted to remain loyal to traditions and especially to his mentor Wilhelm Wundt. There is no doubt that he reformed psychiatric asylums by liberating patients from many literal and metaphoric chains. At the same time, he was accused of lacking empathy and compassion to his patients. Kraepelin was apparently honest and uncompromised in the pursuit of scientific truth. Nevertheless, he was an opinionated and narrow-minded conservative regarding many societal and political issues. We hope that this special issue helps to understand Emil Kraepelin in all his complexity and controversy.

Addresses:

Juri Allik

Institute of Psychology

University of Tartu, Tartu, Estonia.

E-mail: juri.allik@ut.ee

Erki Tammiksaar

Baer House

Veski st. 4

Tartu 51005, Estonia

E-mail: erki.tammiksaar@emu.ee

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(1) Dorpat was the official German name to the town in the Estonian area (from the 13th century to 1893). In the course of the Russification of the Baltic provinces in 1893, the town was renamed Yur'ev (also Jurjew). Since 1919 it has been called Tartu.

(2) Father of Adolf Strumpell (1853-1925), Ludwig Strumpell (1812-1899) was the professor of philosophy (1843-1871) at Dorpat. His Die Natur und Entstehung der Traume /Nature and formation of dreams/ (1874) was an inspiration for Sigmund Freud's own concept of dreams. Interestingly, Adolf Strumpell wrote a sympathetic review about Studies on Hysteria (1985) by Freud and Breuer in which he proposed that doctors might suggest sexual causes of hysteria to receptive patients (Sulloway 1992:81-82).

(3) Schmidt was a world-class scientist who demonstrated that blood coagulation is an enzymatic process in which fibrinogen transforms into fibrin.

(4) The actual quote from Hemingway's book To Have and Have Not (1937) is much better: "No well-run yacht basin in Southern waters is complete without at least two sunburned, salt bleached-headed Esthonians who are waiting for a check from their last article."

(5) Charles Darwin wrote in The Origin of Species about Keyserling: "In 1853 a celebrated geologist, Count Keyserling ("Bulletin de la Soc. Geolog.," 2nd Ser., tom. x. p. 357), suggested that as new diseases, supposed to have been caused by some miasma, have arisen and spread over the world, so at certain periods the germs of existing species may have been chemically affected by circumambient molecules of a particular nature, and thus have given rise to new forms." (Darwin, 1959/1859, p. 68).

Juri Allik [1] and Erki Tammiksaar [1,2]

[1] University of Tartu and [2] Estonian University of Life Sciences
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