The Invention of a Disease

How dementia praecox reached America through a murder trial, was renamed into a confusion, and was replaced by a manual commissioned about psychiatry's reputation.

A course on the thought of Diagnosis.

Psychology · Medicine

What you will learn

• Describe how dementia praecox first reached the American public.
• Explain why a courtroom is an unusual and consequential place for a diagnosis to debut.
• State what the defence's counter-coinage was doing rhetorically.
• Describe how a diagnosis was constructed before disease specificity.
• State what the doctrine of disease specificity claims and what it denies.
• Explain what is gained and what is lost when a diagnosis stops describing an individual.
• State what Kraepelin's dementia praecox was defined by, and what it was not defined by.
• Explain what it means for a category to have no pathognomonic sign.

Course outline

1. The Word Entered Through a Courtroom — In 1907 a millionaire's murder trial put a German diagnosis on American front pages for the first time. The defence mocked it, the jury hung, and the word stayed.
2. Governess Psychosis — Before the 1860s a diagnosis named what had happened to a particular person. Then disease became a thing with an existence of its own, and the person stopped being the unit.
3. Diagnosed by Its Ending — Kraepelin's dementia praecox had no defining symptom. Two patients could present completely differently and have the same disease, because what the diagnosis named was not the illness but its outcome.
4. Six Hundred and Forty-Seven — Around 1907 Bleuler and Jung went through eight years of Burghölzli case records looking at what had actually become of the patients. What they found contradicted Kraepelin — and produced a new name…
5. The Word That Was Not a Synonym — A handful of Americans had been to Zurich and knew the two diseases were different. The hundreds who had not treated the new word as a translation of the old — and then the old one disappeared…
6. A Special Policy Meeting — DSM-III is usually told as a scientific revolution. It was fifty years in the making, and the meeting that commissioned it was called about psychiatry's public image — partly in response to a study…

Terms introduced

dementia praecox, disease specificity, prognosis, pathognomonic, nosology, diagnostic criteria, reliability, operational definition

Part of the Simposeum course library.