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Emil Kraepelin

Emil Wilhelm Georg Magnus Kraepelin (/ˈkrɛpəlɪn/; German: [ˈeːmiːl 'kʁɛːpəliːn]; 15 February 1856 – 7 October 1926) was a German psychiatrist. H. J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

Emil Kraepelin
Emil Kraepelin in his later years
Born(1856-02-15)15 February 1856
Died7 October 1926(1926-10-07) (aged 70)
NationalityGerman
Alma materLeipzig University
University of Würzburg
(MBBS, 1878)
Ludwig Maximilian University of Munich
(Dr. hab. med., 1882)
Known forClassification of mental disorders,
Kraepelinian dichotomy
SpouseIna Marie Marie Wilhelmine Schwabe[1]
Children2 sons, 6 daughters[1]
Scientific career
FieldsPsychiatry
InstitutionsLeipzig University
University of Dorpat
University of Heidelberg
Ludwig Maximilian University of Munich
ThesisThe Place of Psychology in Psychiatry (1882)
Signature

Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century's end. While he proclaimed his own high clinical standards of gathering information "by means of expert analysis of individual cases", he also drew on reported observations of officials not trained in psychiatry.

His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviors from patients with a specific diagnosis. He has been described as "a scientific manager" and "a political operator", who developed "a large-scale, clinically oriented, epidemiological research programme".[2][3]

Family and early life edit

Kraepelin, whose father, Karl Wilhelm, was a former opera singer, music teacher, and later successful story teller,[4] was born in 1856 in Neustrelitz, in the Duchy of Mecklenburg-Strelitz in Germany. He was first introduced to biology by his brother Karl, 10 years older and, later, the director of the Zoological Museum of Hamburg.[5]

Education and career edit

 
Grave in Heidelberg (2008)

Kraepelin began his medical studies in 1874 at the University of Leipzig and completed them at the University of Würzburg (1877–78).[1] At Leipzig, he studied neuropathology under Paul Flechsig and experimental psychology with Wilhelm Wundt. Kraepelin would be a disciple of Wundt and had a lifelong interest in experimental psychology based on his theories. While there, Kraepelin wrote a prize-winning essay, "The Influence of Acute Illness in the Causation of Mental Disorders".[6]

At Würzburg he completed his Rigorosum (roughly equivalent to an MBBS viva-voce examination) in March 1878, his Staatsexamen (licensing examination) in July 1878, and his Approbation (his license to practice medicine; roughly equivalent to an MBBS) on 9 August 1878.[1] From August 1878 to 1882,[1] he worked with Bernhard von Gudden at the University of Munich.

Returning to the University of Leipzig in February 1882,[1] he worked in Wilhelm Heinrich Erb's neurology clinic and in Wundt's psychopharmacology laboratory.[6] He completed his habilitation thesis at Leipzig;[1] it was entitled "The Place of Psychology in Psychiatry".[6] On 3 December 1883 he completed his umhabilitation ("rehabilitation" = habilitation recognition procedure) at Munich.[1]

Kraepelin's major work, Compendium der Psychiatrie: Zum Gebrauche für Studirende und Aerzte (Compendium of Psychiatry: For the Use of Students and Physicians), was first published in 1883 and was expanded in subsequent multivolume editions to Ein Lehrbuch der Psychiatrie (A Textbook: Foundations of Psychiatry and Neuroscience). In it, he argued that psychiatry was a branch of medical science and should be investigated by observation and experimentation like the other natural sciences. He called for research into the physical causes of mental illness, and started to establish the foundations of the modern classification system for mental disorders. Kraepelin proposed that by studying case histories and identifying specific disorders, the progression of mental illness could be predicted, after taking into account individual differences in personality and patient age at the onset of disease.[6]

In 1884, he became senior physician in the Prussian provincial town of Leubus, Silesia Province, and the following year he was appointed director of the Treatment and Nursing Institute in Dresden. On 1 July 1886,[1] at the age of 30, Kraepelin was named Professor of Psychiatry at the University of Dorpat (today the University of Tartu) in what is today Tartu, Estonia (see Burgmair et al., vol. IV). Four years later, on 5 December 1890,[1] he became department head at the University of Heidelberg, where he remained until 1904.[6] While at Dorpat he became the director of the 80-bed University Clinic, where he began to study and record many clinical histories in detail and "was led to consider the importance of the course of the illness with regard to the classification of mental disorders".

In 1903, Kraepelin moved to Munich to become Professor of Clinical Psychiatry at the University of Munich.[7]

In 1908, he was elected a member of the Royal Swedish Academy of Sciences.[citation needed]

In 1912, at the request of the DVP (Deutscher Verein für Psychiatrie; German Association for Psychiatry),[8] of which he was the head from 1906 to 1920, he began plans to establish a centre for research. Following a large donation from the Jewish German-American banker James Loeb, who had at one time been a patient, and promises of support from "patrons of science", the German Institute for Psychiatric Research was founded in 1917 in Munich.[9][10] Initially housed in existing hospital buildings, it was maintained by further donations from Loeb and his relatives. In 1924 it came under the auspices of the Kaiser Wilhelm Society for the Advancement of Science. The German-American Rockefeller family's Rockefeller Foundation made a large donation enabling the development of a new dedicated building for the institute along Kraepelin's guidelines, which was officially opened in 1928.[6]

Kraepelin spoke out against the barbarous treatment that was prevalent in the psychiatric asylums of the time, and crusaded against alcohol, capital punishment and the imprisonment rather than treatment of the insane. For the sedation of agitated patients, Kraepelin recommended potassium bromide.[11] He rejected psychoanalytical theories that posited innate or early sexuality as the cause of mental illness, and he rejected philosophical speculation as unscientific. He focused on collecting clinical data and was particularly interested in neuropathology (e.g., diseased tissue).[6]

In the later period of his career, as a convinced champion of social Darwinism, he actively promoted a policy and research agenda in racial hygiene and eugenics.[12]

Kraepelin retired from teaching at the age of 66, spending his remaining years establishing the institute. The ninth and final edition of his Textbook was published in 1927, shortly after his death. It comprised four volumes and was ten times larger than the first edition of 1883.[6]

In the last years of his life, Kraepelin was preoccupied with Buddhist teachings and was planning to visit Buddhist shrines at the time of his death, according to his daughter, Antonie Schmidt-Kraepelin.[13]

Theories and classification schemes edit

Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as "symptomatic" and to his view as "clinical". This turned out to be his paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of syndrome—common patterns of symptoms over time—rather than by simple similarity of major symptoms in the manner of his predecessors.

Kraepelin described his work in the 5th edition of his textbook as a "decisive step from a symptomatic to a clinical view of insanity. . . . The importance of external clinical signs has . . . been subordinated to consideration of the conditions of origin, the course, and the terminus which result from individual disorders. Thus, all purely symptomatic categories have disappeared from the nosology".[14]

Psychosis and mood edit

Kraepelin is specifically credited with the classification of what was previously considered to be a unitary concept of psychosis, into two distinct forms (known as the Kraepelinian dichotomy):

Drawing on his long-term research, and using the criteria of course, outcome and prognosis, he developed the concept of dementia praecox, which he defined as the "sub-acute development of a peculiar simple condition of mental weakness occurring at a youthful age". When he first introduced this concept as a diagnostic entity in the fourth German edition of his Lehrbuch der Psychiatrie in 1893, it was placed among the degenerative disorders alongside, but separate from, catatonia and dementia paranoides. At that time, the concept corresponded by and large with Ewald Hecker's hebephrenia. In the sixth edition of the Lehrbuch in 1899 all three of these clinical types are treated as different expressions of one disease, dementia praecox.[16]

One of the cardinal principles of his method was the recognition that any given symptom may appear in virtually any one of these disorders; e.g., there is almost no single symptom occurring in dementia praecox which cannot sometimes be found in manic depression. What distinguishes each disease symptomatically (as opposed to the underlying pathology) is not any particular (pathognomonic) symptom or symptoms, but a specific pattern of symptoms. In the absence of a direct physiological or genetic test or marker for each disease, it is only possible to distinguish them by their specific pattern of symptoms. Thus, Kraepelin's system is a method for pattern recognition, not grouping by common symptoms.

It has been claimed that Kraepelin also demonstrated specific patterns in the genetics of these disorders and patterns in their course and outcome,[17] but no specific biomarkers have yet been identified. Generally speaking, there tend to be more people with schizophrenia among the relatives of schizophrenic patients than in the general population, while manic depression is more frequent in the relatives of manic depressives. Though, of course, this does not demonstrate genetic linkage, as this might be a socio-environmental factor as well.

He also reported a pattern to the course and outcome of these conditions. Kraepelin believed that schizophrenia had a deteriorating course in which mental function continuously (although perhaps erratically) declines, while manic-depressive patients experienced a course of illness which was intermittent, where patients were relatively symptom-free during the intervals which separate acute episodes. This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the dementia part signifying the irreversible mental decline). It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed schizophrenia by Eugen Bleuler to correct Kraepelin's misnomer.

In addition, as Kraepelin accepted in 1920, "It is becoming increasingly obvious that we cannot satisfactorily distinguish these two diseases"; however, he maintained that "On the one hand we find those patients with irreversible dementia and severe cortical lesions. On the other are those patients whose personality remains intact".[18] Nevertheless, overlap between the diagnoses and neurological abnormalities (when found) have continued, and in fact a diagnostic category of schizoaffective disorder would be brought in to cover the intermediate cases.

Kraepelin devoted very few pages to his speculations about the etiology of his two major insanities, dementia praecox and manic-depressive insanity. However, from 1896 to his death in 1926 he held to the speculation that these insanities (particularly dementia praecox) would one day probably be found to be caused by a gradual systemic or "whole body" disease process, probably metabolic, which affected many of the organs and nerves in the body but affected the brain in a final, decisive cascade.[19]

Psychopathic personalities edit

In the first through sixth edition of Kraepelin's influential psychiatry textbook, there was a section on moral insanity, which meant then a disorder of the emotions or moral sense without apparent delusions or hallucinations, and which Kraepelin defined as "lack or weakness of those sentiments which counter the ruthless satisfaction of egotism". He attributed this mainly to degeneration. This has been described as a psychiatric redefinition of Cesare Lombroso's theories of the "born criminal", conceptualised as a "moral defect", though Kraepelin stressed it was not yet possible to recognise them by physical characteristics.[20]

In fact from 1904 Kraepelin changed the section heading to "The born criminal", moving it from under "Congenital feeble-mindedness" to a new chapter on "Psychopathic personalities". They were treated under a theory of degeneration. Four types were distinguished: born criminals (inborn delinquents), pathological liars, querulous persons, and Triebmenschen (persons driven by a basic compulsion, including vagabonds, spendthrifts, and dipsomaniacs).

The concept of "psychopathic inferiorities" had been recently popularised in Germany by Julius Ludwig August Koch, who proposed congenital and acquired types. Kraepelin had no evidence or explanation suggesting a congenital cause, and his assumption therefore appears to have been simple "biologism". Others, such as Gustav Aschaffenburg, argued for a varying combination of causes. Kraepelin's assumption of a moral defect rather than a positive drive towards crime has also been questioned, as it implies that the moral sense is somehow inborn and unvarying, yet it was known to vary by time and place, and Kraepelin never considered that the moral sense might just be different.

Kurt Schneider criticized Kraepelin's nosology on topics such as Haltlose for appearing to be a list of behaviors that he considered undesirable, rather than medical conditions, though Schneider's alternative version has also been criticised on the same basis. Nevertheless, many essentials of these diagnostic systems were introduced into the diagnostic systems, and remarkable similarities remain in the DSM-V and ICD-10.[20] The issues would today mainly be considered under the category of personality disorders, or in terms of Kraepelin's focus on psychopathy.

Kraepelin had referred to psychopathic conditions (or "states") in his 1896 edition, including compulsive insanity, impulsive insanity, homosexuality, and mood disturbances. From 1904, however, he instead termed those "original disease conditions, and introduced the new alternative category of psychopathic personalities. In the eighth edition from 1909 that category would include, in addition to a separate "dissocial" type, the excitable, the unstable, the Triebmenschen driven persons, eccentrics, the liars and swindlers, and the quarrelsome. It has been described as remarkable that Kraepelin now considered mood disturbances to be not part of the same category, but only attenuated (more mild) phases of manic depressive illness; this corresponds to current classification schemes.[21]

Alzheimer's disease edit

Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders.[citation needed] As a colleague of Alois Alzheimer, he was a co-discoverer of Alzheimer's disease, and his laboratory discovered its pathological basis. Kraepelin was confident that it would someday be possible to identify the pathological basis of each of the major psychiatric disorders.[citation needed]

Eugenics edit

Upon moving to become Professor of Clinical Psychiatry at the University of Munich in 1903, Kraepelin increasingly wrote on social policy issues. He was a strong and influential proponent of eugenics and racial hygiene. His publications included a focus on alcoholism, crime, degeneration and hysteria.[2]

Kraepelin was convinced that such institutions as the education system and the welfare state, because of their trend to break the processes of natural selection, undermined the Germans' biological "struggle for survival".[12] He was concerned to preserve and enhance the German people, the Volk, in the sense of nation or race. He appears to have held Lamarckian concepts of evolution, such that cultural deterioration could be inherited. He was a strong ally and promoter of the work of fellow psychiatrist (and pupil and later successor as director of the clinic) Ernst Rüdin to clarify the mechanisms of genetic inheritance as to make a so-called "empirical genetic prognosis".[2]

Martin Brune has pointed out that Kraepelin and Rüdin also appear to have been ardent advocates of a self-domestication theory, a version of social Darwinism which held that modern culture was not allowing people to be weeded out, resulting in more mental disorder and deterioration of the gene pool. Kraepelin saw a number of "symptoms" of this, such as "weakening of viability and resistance, decreasing fertility, proletarianisation, and moral damage due to "penning up people" [Zusammenpferchung]. He also wrote that "the number of idiots, epileptics, psychopaths, criminals, prostitutes, and tramps who descend from alcoholic and syphilitic parents, and who transfer their inferiority to their offspring, is incalculable". He felt that "the well-known example of the Jews, with their strong disposition towards nervous and mental disorders, teaches us that their extraordinarily advanced domestication may eventually imprint clear marks on the race". Brune states that Kraepelin's nosological system "was, to a great deal, built on the degeneration paradigm".[22]

Influence edit

Kraepelin's great contribution in classifying schizophrenia and manic depression remains relatively unknown to the general public, and his work, which had neither the literary quality nor paradigmatic power of Freud's, is little read outside scholarly circles. Kraepelin's contributions were also to a large extent marginalized throughout a good part of the 20th century during the success of Freudian etiological theories. However, his views now dominate many quarters of psychiatric research and academic psychiatry. His fundamental theories on the diagnosis of psychiatric disorders form the basis of the major diagnostic systems in use today, especially the American Psychiatric Association's DSM-IV and the World Health Organization's ICD system, based on the Research Diagnostic Criteria and earlier Feighner Criteria developed by espoused "neo-Kraepelinians", though Robert Spitzer and others in the DSM committees were keen not to include assumptions about causation as Kraepelin had.[14][23]

Kraepelin has been described as a "scientific manager"[24][25] and political operator, who developed a large-scale, clinically oriented, epidemiological research programme. In this role he took in clinical information from a wide range of sources and networks. Despite proclaiming high clinical standards for himself to gather information "by means of expert analysis of individual cases", he would also draw on the reported observations of officials not trained in psychiatry. The various editions of his textbooks do not contain detailed case histories of individuals, however, but mosaiclike compilations of typical statements and behaviors from patients with a specific diagnosis.

Kraepelin wrote in a knapp und klar (concise and clear) style that made his books useful tools for physicians. Abridged and clumsy English translations of the sixth and seventh editions of his textbook in 1902 and 1907 (respectively) by Allan Ross Diefendorf (1871–1943), an assistant physician at the Connecticut Hospital for the Insane at Middletown, inadequately conveyed the literary quality of his writings that made them so valuable to practitioners.[26]

Among the doctors trained by Alois Alzheimer and Emil Kraepelin at Munich at the beginning of the 20th century were the Spanish neuropathologists and neuropsychiatrists Nicolás Achúcarro and Gonzalo Rodríguez Lafora, two distinguished disciples of Santiago Ramón y Cajal and members of the Spanish Neurological School.

Dreaming for psychiatry's sake edit

In the Heidelberg and early Munich years he edited Psychologische Arbeiten, a journal on experimental psychology. One of his own famous contributions to this journal also appeared in the form of a monograph (105 pp.) entitled Über Sprachstörungen im Traume (On Language Disturbances in Dreams).[27] Kraepelin, on the basis of the dream-psychosis analogy, studied for more than 20 years language disorder in dreams in order to study indirectly schizophasia. The dreams Kraepelin collected are mainly his own. They lack extensive comment by the dreamer. In order to study them the full range of biographical knowledge available today on Kraepelin is necessary (see, e.g., Burgmair et al., I-IX).

Bibliography edit

  • Kraepelin, E. (1906). Über Sprachstörungen im Traume. Leipzig: Engelmann. ([1] Online.)
  • Kraepelin, E. (1987). Memoirs. Berlin, Heidelberg, New York: Springer-Verlag. ISBN 978-3-642-71926-4.

Collected works edit

See also edit

References edit

  1. ^ a b c d e f g h i j Dagmar Drüll, Heidelberger Gelehrtenlexikon: 1803–1932, Springer-Verlag, 2013, p. 149.
  2. ^ a b c Engstrom, E. J. (1 September 2007). (PDF). History of Psychiatry. 18 (3): 389–398. doi:10.1177/0957154X07079689. PMID 18175639. S2CID 46482747. Archived from the original (PDF) on 26 May 2013..
  3. ^ Shepherd, M. (1 August 1995). "Two faces of Emil Kraepelin". The British Journal of Psychiatry. 167 (2): 174–183. doi:10.1192/bjp.167.2.174. PMID 7582666. S2CID 37204909.
  4. ^ Peter Barham (2004), Forgotten Lunatics of the Great War (New Haven: Yale), p. 163 n. 47.
  5. ^ On Kraepelin's early life and family, see Burgmair et al., vol. I, as well as his Memoirs (Berlin: Springer, 1987).
  6. ^ a b c d e f g h "Kraepelin, Emil (1856–1926)" by Margaret Alic, Gale Encyclopedia of Psychology, 2001.
  7. ^ "Klinik für Psychiatrie und Psychotherapie, Historie". LMU Klinikum München. Retrieved 10 June 2021.
  8. ^ See (1) German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology and (2) History of the DGPPN
  9. ^ Burgmair, Wolfgang, and Matthias M. Weber. "'Das Geld ist gut angelegt, und du brauchst keine Reue zu haben': James Loeb, ein deutsch-amerikanischer Wissenschaftsmäzen zwischen Kaiserreich und Weimarer Republik." Historische Zeitschrift 277 (2003): 343–378.
  10. ^ James Loeb Harvard University Press.
  11. ^ Hans C. Bangen: Geschichte der medikamentösen Therapie der Schizophrenie. VWB, Berlin 1992, ISBN 3-927408-82-4
  12. ^ a b Engstrom EJ, Weber MM, Burgmair W (October 2006). "Emil Wilhelm Magnus Georg Kraepelin (1856–1926)". The American Journal of Psychiatry. 163 (10): 1710. doi:10.1176/appi.ajp.163.10.1710. PMID 17012678..
  13. ^ Shepherd, Michael (1990). Conceptual Issues in Psychological Medicine. London: Tavistock/Routledge. p. 230. ISBN 978-0415165303.
  14. ^ a b Decker Hannah S (2007). (PDF). History of Psychiatry. 18 (3): 337–360. doi:10.1177/0957154X07078976. PMID 18175636. S2CID 19754009. Archived from the original (PDF) on 29 October 2013.
  15. ^ Teodoro T, Durval R (October 2022). "Emil Kraepelin's taxonomic unitary view of manic-depressive insanity in the 21st century: the never-ending diagnostic conundrum of bipolar depression". CNS Spectrums. 28 (4): 389–390. doi:10.1017/s109285292200102x. PMID 36210529. S2CID 252779392.
  16. ^ Yuhas, Daisy (March 2013). "Throughout History, Defining Schizophrenia Has Remained a Challenge (Timeline)". Scientific American Mind (March 2013). Retrieved 2 March 2013..
  17. ^ Ebert, Andreas (2010). "Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology". Indian Journal of Psychiatry. 52 (2): 191–2. doi:10.4103/0019-5545.64591. PMC 2927892. PMID 20838510.
  18. ^ Berrios GE, Luque R, Villagran JM (2003). "Schizophrenia: a conceptual history" (PDF). International Journal of Psychology and Psychological Therapy. 3 (2): 111–140.
  19. ^ Noll, Richard. "Whole Body Madness". Psychiatric Times. Retrieved 26 September 2012..
  20. ^ a b Richard Wetzell (2000) Inventing the criminal: a history of German criminology, 1880–1945 from p 59 & 146, misc.
  21. ^ Henning Sass & Alan Felthous (2008) Chapter 1: History and Conceptual Development of Psychopathic Disorders in International Handbook on Psychopathic Disorders and the Law. Edited by Alan Felthous, Henning Sass.
  22. ^ Brüne, Martin (1 January 2007). "On human self-domestication, psychiatry, and eugenics". Philosophy, Ethics, and Humanities in Medicine. 2 (1): 21. doi:10.1186/1747-5341-2-21. PMC 2082022. PMID 17919321.
  23. ^ Engstrom Eric J., Weber Matthias (2007). (PDF). History of Psychiatry. 18 (3): 267–273. doi:10.1177/0957154x07080819. S2CID 144482013. Archived from the original (PDF) on 29 October 2013.
  24. ^ Engstrom, Eric J. "Organizing Psychiatric Research in Munich (1903–1925): A Psychiatric Zoon Politicon between State Bureaucracy and American Philanthropy." In International Relations in Psychiatry: Britain, Germany, and the United States through World War II, edited by Volker Roelcke, Paul J. Weindling, and Louise Westwood, 48–66. Rochester: University of Rochester Press, 2010.
  25. ^ Engstrom, Eric; Weber, Matthias; Burgmair, Wolfgang (2016). "Psychiatric Governance, völkisch Corporatism, and the German Research Institute for Psychiatry in Munich (1912–1926)". History of Psychiatry. 27 (1/2): 38–50, 137–152. doi:10.1177/0957154x15623692. PMID 26823087. S2CID 21375412.
  26. ^ Noll, Richard. "The Bed Makes Gestures". Psychiatric times. Retrieved 8 February 2013..
  27. ^ Über Sprachstörungen im Traume (1906).

Sources edit

  • Noll, Richard (2011) American Madness: The Rise and Fall of Dementia Praecox. Cambridge and London: Harvard University Press.
  • Briole G (2012). "Emil Kraepelin: The Fragility of a Colossal Oeuvre". Hurly-Burly. 8: 125–147.

External links edit

  • Extensive bibliography of works by and about Kraepelin's including those in the original German @ psych.mpg.de
  • Kraepelin's monograph Über Sprachstörungen im Traume
  • at the Wayback Machine (archived 23 December 2019)
  • Newspaper clippings about Emil Kraepelin in the 20th Century Press Archives of the ZBW

For biographies of Kraepelin see:

  • engstrom.de/KRAEPELINBIOGRAPHY.pdf
  • Burkhart Brückner, Julian Schwarz: Biography of Emil Wilhelm Georg Magnus Kraepelin in: Biographical Archive of Psychiatry (BIAPSY).

For English translations of Kraepelin's work see:

  • On Uprootedness (1921)
  • Emil Kraepelin's Clinical Self-Assessment (1920)
  • Psychiatric Observations on Contemporary Issues (1919)
  • On the Question of Degeneration (1908)
  • The Directions of Psychiatric Research (1887)

emil, kraepelin, emil, wilhelm, georg, magnus, kraepelin, german, ˈeːmiːl, kʁɛːpəliːn, february, 1856, october, 1926, german, psychiatrist, eysenck, encyclopedia, psychology, identifies, founder, modern, scientific, psychiatry, psychopharmacology, psychiatric,. Emil Wilhelm Georg Magnus Kraepelin ˈ k r ɛ p el ɪ n German ˈeːmiːl kʁɛːpeliːn 15 February 1856 7 October 1926 was a German psychiatrist H J Eysenck s Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry psychopharmacology and psychiatric genetics Emil KraepelinEmil Kraepelin in his later yearsBorn 1856 02 15 15 February 1856Neustrelitz Grand Duchy of Mecklenburg Strelitz German ConfederationDied7 October 1926 1926 10 07 aged 70 Munich Bavaria Weimar GermanyNationalityGermanAlma materLeipzig UniversityUniversity of Wurzburg MBBS 1878 Ludwig Maximilian University of Munich Dr hab med 1882 Known forClassification of mental disorders Kraepelinian dichotomySpouseIna Marie Marie Wilhelmine Schwabe 1 Children2 sons 6 daughters 1 Scientific careerFieldsPsychiatryInstitutionsLeipzig University University of DorpatUniversity of HeidelbergLudwig Maximilian University of MunichThesisThe Place of Psychology in Psychiatry 1882 SignatureKraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction His theories dominated psychiatry at the start of the 20th century and despite the later psychodynamic influence of Sigmund Freud and his disciples enjoyed a revival at century s end While he proclaimed his own high clinical standards of gathering information by means of expert analysis of individual cases he also drew on reported observations of officials not trained in psychiatry His textbooks do not contain detailed case histories of individuals but mosaic like compilations of typical statements and behaviors from patients with a specific diagnosis He has been described as a scientific manager and a political operator who developed a large scale clinically oriented epidemiological research programme 2 3 Contents 1 Family and early life 2 Education and career 3 Theories and classification schemes 3 1 Psychosis and mood 3 2 Psychopathic personalities 3 3 Alzheimer s disease 3 4 Eugenics 4 Influence 5 Dreaming for psychiatry s sake 6 Bibliography 6 1 Collected works 7 See also 8 References 9 Sources 10 External linksFamily and early life editKraepelin whose father Karl Wilhelm was a former opera singer music teacher and later successful story teller 4 was born in 1856 in Neustrelitz in the Duchy of Mecklenburg Strelitz in Germany He was first introduced to biology by his brother Karl 10 years older and later the director of the Zoological Museum of Hamburg 5 Education and career edit nbsp Grave in Heidelberg 2008 Kraepelin began his medical studies in 1874 at the University of Leipzig and completed them at the University of Wurzburg 1877 78 1 At Leipzig he studied neuropathology under Paul Flechsig and experimental psychology with Wilhelm Wundt Kraepelin would be a disciple of Wundt and had a lifelong interest in experimental psychology based on his theories While there Kraepelin wrote a prize winning essay The Influence of Acute Illness in the Causation of Mental Disorders 6 At Wurzburg he completed his Rigorosum roughly equivalent to an MBBS viva voce examination in March 1878 his Staatsexamen licensing examination in July 1878 and his Approbation his license to practice medicine roughly equivalent to an MBBS on 9 August 1878 1 From August 1878 to 1882 1 he worked with Bernhard von Gudden at the University of Munich Returning to the University of Leipzig in February 1882 1 he worked in Wilhelm Heinrich Erb s neurology clinic and in Wundt s psychopharmacology laboratory 6 He completed his habilitation thesis at Leipzig 1 it was entitled The Place of Psychology in Psychiatry 6 On 3 December 1883 he completed his umhabilitation rehabilitation habilitation recognition procedure at Munich 1 Kraepelin s major work Compendium der Psychiatrie Zum Gebrauche fur Studirende und Aerzte Compendium of Psychiatry For the Use of Students and Physicians was first published in 1883 and was expanded in subsequent multivolume editions to Ein Lehrbuch der Psychiatrie A Textbook Foundations of Psychiatry and Neuroscience In it he argued that psychiatry was a branch of medical science and should be investigated by observation and experimentation like the other natural sciences He called for research into the physical causes of mental illness and started to establish the foundations of the modern classification system for mental disorders Kraepelin proposed that by studying case histories and identifying specific disorders the progression of mental illness could be predicted after taking into account individual differences in personality and patient age at the onset of disease 6 In 1884 he became senior physician in the Prussian provincial town of Leubus Silesia Province and the following year he was appointed director of the Treatment and Nursing Institute in Dresden On 1 July 1886 1 at the age of 30 Kraepelin was named Professor of Psychiatry at the University of Dorpat today the University of Tartu in what is today Tartu Estonia see Burgmair et al vol IV Four years later on 5 December 1890 1 he became department head at the University of Heidelberg where he remained until 1904 6 While at Dorpat he became the director of the 80 bed University Clinic where he began to study and record many clinical histories in detail and was led to consider the importance of the course of the illness with regard to the classification of mental disorders In 1903 Kraepelin moved to Munich to become Professor of Clinical Psychiatry at the University of Munich 7 In 1908 he was elected a member of the Royal Swedish Academy of Sciences citation needed In 1912 at the request of the DVP Deutscher Verein fur Psychiatrie German Association for Psychiatry 8 of which he was the head from 1906 to 1920 he began plans to establish a centre for research Following a large donation from the Jewish German American banker James Loeb who had at one time been a patient and promises of support from patrons of science the German Institute for Psychiatric Research was founded in 1917 in Munich 9 10 Initially housed in existing hospital buildings it was maintained by further donations from Loeb and his relatives In 1924 it came under the auspices of the Kaiser Wilhelm Society for the Advancement of Science The German American Rockefeller family s Rockefeller Foundation made a large donation enabling the development of a new dedicated building for the institute along Kraepelin s guidelines which was officially opened in 1928 6 Kraepelin spoke out against the barbarous treatment that was prevalent in the psychiatric asylums of the time and crusaded against alcohol capital punishment and the imprisonment rather than treatment of the insane For the sedation of agitated patients Kraepelin recommended potassium bromide 11 He rejected psychoanalytical theories that posited innate or early sexuality as the cause of mental illness and he rejected philosophical speculation as unscientific He focused on collecting clinical data and was particularly interested in neuropathology e g diseased tissue 6 In the later period of his career as a convinced champion of social Darwinism he actively promoted a policy and research agenda in racial hygiene and eugenics 12 Kraepelin retired from teaching at the age of 66 spending his remaining years establishing the institute The ninth and final edition of his Textbook was published in 1927 shortly after his death It comprised four volumes and was ten times larger than the first edition of 1883 6 In the last years of his life Kraepelin was preoccupied with Buddhist teachings and was planning to visit Buddhist shrines at the time of his death according to his daughter Antonie Schmidt Kraepelin 13 Theories and classification schemes editKraepelin announced that he had found a new way of looking at mental illness referring to the traditional view as symptomatic and to his view as clinical This turned out to be his paradigm setting synthesis of the hundreds of mental disorders classified by the 19th century grouping diseases together based on classification of syndrome common patterns of symptoms over time rather than by simple similarity of major symptoms in the manner of his predecessors Kraepelin described his work in the 5th edition of his textbook as a decisive step from a symptomatic to a clinical view of insanity The importance of external clinical signs has been subordinated to consideration of the conditions of origin the course and the terminus which result from individual disorders Thus all purely symptomatic categories have disappeared from the nosology 14 Psychosis and mood edit Kraepelin is specifically credited with the classification of what was previously considered to be a unitary concept of psychosis into two distinct forms known as the Kraepelinian dichotomy manic depression although commonly presented as synonym with bipolar disorder that is inaccurate manic depressive illness encompasses a broader spectrum of mood disorders such as bipolar disorder and recurrent major depression 15 and dementia praecox Drawing on his long term research and using the criteria of course outcome and prognosis he developed the concept of dementia praecox which he defined as the sub acute development of a peculiar simple condition of mental weakness occurring at a youthful age When he first introduced this concept as a diagnostic entity in the fourth German edition of his Lehrbuch der Psychiatrie in 1893 it was placed among the degenerative disorders alongside but separate from catatonia and dementia paranoides At that time the concept corresponded by and large with Ewald Hecker s hebephrenia In the sixth edition of the Lehrbuch in 1899 all three of these clinical types are treated as different expressions of one disease dementia praecox 16 One of the cardinal principles of his method was the recognition that any given symptom may appear in virtually any one of these disorders e g there is almost no single symptom occurring in dementia praecox which cannot sometimes be found in manic depression What distinguishes each disease symptomatically as opposed to the underlying pathology is not any particular pathognomonic symptom or symptoms but a specific pattern of symptoms In the absence of a direct physiological or genetic test or marker for each disease it is only possible to distinguish them by their specific pattern of symptoms Thus Kraepelin s system is a method for pattern recognition not grouping by common symptoms It has been claimed that Kraepelin also demonstrated specific patterns in the genetics of these disorders and patterns in their course and outcome 17 but no specific biomarkers have yet been identified Generally speaking there tend to be more people with schizophrenia among the relatives of schizophrenic patients than in the general population while manic depression is more frequent in the relatives of manic depressives Though of course this does not demonstrate genetic linkage as this might be a socio environmental factor as well He also reported a pattern to the course and outcome of these conditions Kraepelin believed that schizophrenia had a deteriorating course in which mental function continuously although perhaps erratically declines while manic depressive patients experienced a course of illness which was intermittent where patients were relatively symptom free during the intervals which separate acute episodes This led Kraepelin to name what we now know as schizophrenia dementia praecox the dementia part signifying the irreversible mental decline It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed schizophrenia by Eugen Bleuler to correct Kraepelin s misnomer In addition as Kraepelin accepted in 1920 It is becoming increasingly obvious that we cannot satisfactorily distinguish these two diseases however he maintained that On the one hand we find those patients with irreversible dementia and severe cortical lesions On the other are those patients whose personality remains intact 18 Nevertheless overlap between the diagnoses and neurological abnormalities when found have continued and in fact a diagnostic category of schizoaffective disorder would be brought in to cover the intermediate cases Kraepelin devoted very few pages to his speculations about the etiology of his two major insanities dementia praecox and manic depressive insanity However from 1896 to his death in 1926 he held to the speculation that these insanities particularly dementia praecox would one day probably be found to be caused by a gradual systemic or whole body disease process probably metabolic which affected many of the organs and nerves in the body but affected the brain in a final decisive cascade 19 Psychopathic personalities edit In the first through sixth edition of Kraepelin s influential psychiatry textbook there was a section on moral insanity which meant then a disorder of the emotions or moral sense without apparent delusions or hallucinations and which Kraepelin defined as lack or weakness of those sentiments which counter the ruthless satisfaction of egotism He attributed this mainly to degeneration This has been described as a psychiatric redefinition of Cesare Lombroso s theories of the born criminal conceptualised as a moral defect though Kraepelin stressed it was not yet possible to recognise them by physical characteristics 20 In fact from 1904 Kraepelin changed the section heading to The born criminal moving it from under Congenital feeble mindedness to a new chapter on Psychopathic personalities They were treated under a theory of degeneration Four types were distinguished born criminals inborn delinquents pathological liars querulous persons and Triebmenschen persons driven by a basic compulsion including vagabonds spendthrifts and dipsomaniacs The concept of psychopathic inferiorities had been recently popularised in Germany by Julius Ludwig August Koch who proposed congenital and acquired types Kraepelin had no evidence or explanation suggesting a congenital cause and his assumption therefore appears to have been simple biologism Others such as Gustav Aschaffenburg argued for a varying combination of causes Kraepelin s assumption of a moral defect rather than a positive drive towards crime has also been questioned as it implies that the moral sense is somehow inborn and unvarying yet it was known to vary by time and place and Kraepelin never considered that the moral sense might just be different Kurt Schneider criticized Kraepelin s nosology on topics such as Haltlose for appearing to be a list of behaviors that he considered undesirable rather than medical conditions though Schneider s alternative version has also been criticised on the same basis Nevertheless many essentials of these diagnostic systems were introduced into the diagnostic systems and remarkable similarities remain in the DSM V and ICD 10 20 The issues would today mainly be considered under the category of personality disorders or in terms of Kraepelin s focus on psychopathy Kraepelin had referred to psychopathic conditions or states in his 1896 edition including compulsive insanity impulsive insanity homosexuality and mood disturbances From 1904 however he instead termed those original disease conditions and introduced the new alternative category of psychopathic personalities In the eighth edition from 1909 that category would include in addition to a separate dissocial type the excitable the unstable the Triebmenschen driven persons eccentrics the liars and swindlers and the quarrelsome It has been described as remarkable that Kraepelin now considered mood disturbances to be not part of the same category but only attenuated more mild phases of manic depressive illness this corresponds to current classification schemes 21 Alzheimer s disease edit Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders citation needed As a colleague of Alois Alzheimer he was a co discoverer of Alzheimer s disease and his laboratory discovered its pathological basis Kraepelin was confident that it would someday be possible to identify the pathological basis of each of the major psychiatric disorders citation needed Eugenics edit Upon moving to become Professor of Clinical Psychiatry at the University of Munich in 1903 Kraepelin increasingly wrote on social policy issues He was a strong and influential proponent of eugenics and racial hygiene His publications included a focus on alcoholism crime degeneration and hysteria 2 Kraepelin was convinced that such institutions as the education system and the welfare state because of their trend to break the processes of natural selection undermined the Germans biological struggle for survival 12 He was concerned to preserve and enhance the German people the Volk in the sense of nation or race He appears to have held Lamarckian concepts of evolution such that cultural deterioration could be inherited He was a strong ally and promoter of the work of fellow psychiatrist and pupil and later successor as director of the clinic Ernst Rudin to clarify the mechanisms of genetic inheritance as to make a so called empirical genetic prognosis 2 Martin Brune has pointed out that Kraepelin and Rudin also appear to have been ardent advocates of a self domestication theory a version of social Darwinism which held that modern culture was not allowing people to be weeded out resulting in more mental disorder and deterioration of the gene pool Kraepelin saw a number of symptoms of this such as weakening of viability and resistance decreasing fertility proletarianisation and moral damage due to penning up people Zusammenpferchung He also wrote that the number of idiots epileptics psychopaths criminals prostitutes and tramps who descend from alcoholic and syphilitic parents and who transfer their inferiority to their offspring is incalculable He felt that the well known example of the Jews with their strong disposition towards nervous and mental disorders teaches us that their extraordinarily advanced domestication may eventually imprint clear marks on the race Brune states that Kraepelin s nosological system was to a great deal built on the degeneration paradigm 22 Influence editKraepelin s great contribution in classifying schizophrenia and manic depression remains relatively unknown to the general public and his work which had neither the literary quality nor paradigmatic power of Freud s is little read outside scholarly circles Kraepelin s contributions were also to a large extent marginalized throughout a good part of the 20th century during the success of Freudian etiological theories However his views now dominate many quarters of psychiatric research and academic psychiatry His fundamental theories on the diagnosis of psychiatric disorders form the basis of the major diagnostic systems in use today especially the American Psychiatric Association s DSM IV and the World Health Organization s ICD system based on the Research Diagnostic Criteria and earlier Feighner Criteria developed by espoused neo Kraepelinians though Robert Spitzer and others in the DSM committees were keen not to include assumptions about causation as Kraepelin had 14 23 Kraepelin has been described as a scientific manager 24 25 and political operator who developed a large scale clinically oriented epidemiological research programme In this role he took in clinical information from a wide range of sources and networks Despite proclaiming high clinical standards for himself to gather information by means of expert analysis of individual cases he would also draw on the reported observations of officials not trained in psychiatry The various editions of his textbooks do not contain detailed case histories of individuals however but mosaiclike compilations of typical statements and behaviors from patients with a specific diagnosis Kraepelin wrote in a knapp und klar concise and clear style that made his books useful tools for physicians Abridged and clumsy English translations of the sixth and seventh editions of his textbook in 1902 and 1907 respectively by Allan Ross Diefendorf 1871 1943 an assistant physician at the Connecticut Hospital for the Insane at Middletown inadequately conveyed the literary quality of his writings that made them so valuable to practitioners 26 Among the doctors trained by Alois Alzheimer and Emil Kraepelin at Munich at the beginning of the 20th century were the Spanish neuropathologists and neuropsychiatrists Nicolas Achucarro and Gonzalo Rodriguez Lafora two distinguished disciples of Santiago Ramon y Cajal and members of the Spanish Neurological School Dreaming for psychiatry s sake editIn the Heidelberg and early Munich years he edited Psychologische Arbeiten a journal on experimental psychology One of his own famous contributions to this journal also appeared in the form of a monograph 105 pp entitled Uber Sprachstorungen im Traume On Language Disturbances in Dreams 27 Kraepelin on the basis of the dream psychosis analogy studied for more than 20 years language disorder in dreams in order to study indirectly schizophasia The dreams Kraepelin collected are mainly his own They lack extensive comment by the dreamer In order to study them the full range of biographical knowledge available today on Kraepelin is necessary see e g Burgmair et al I IX Bibliography editKraepelin E 1906 Uber Sprachstorungen im Traume Leipzig Engelmann 1 Online Kraepelin E 1987 Memoirs Berlin Heidelberg New York Springer Verlag ISBN 978 3 642 71926 4 Collected works edit Burgmair Wolfgang amp Eric J Engstrom amp Matthias Weber et al eds Emil Kraepelin 9 vols Munich belleville 2000 2019 Vol I Personliches Selbstzeugnisse 2000 ISBN 3 933510 90 2 Vol II Kriminologische und forensische Schriften Werke und Briefe 2001 ISBN 3 933510 91 0 Vol III Briefe I 1868 1886 2002 ISBN 3 933510 92 9 Vol IV Kraepelin in Dorpat 1886 1891 2003 ISBN 3 933510 93 7 Vol V Kraepelin in Heidelberg 1891 1903 2005 ISBN 3 933510 94 5 Vol VI Kraepelin in Munchen I 1903 1914 2006 ISBN 3 933510 95 3 Vol VII Kraepelin in Munchen II 1914 1920 2009 ISBN 978 3 933510 96 9 Vol VIII Kraepelin in Munchen III 1921 1926 2013 ISBN 978 3 943157 22 2 Vol IX Briefe und Dokumente II 1876 1926 2019 ISBN 978 3 946875 28 4See also edit nbsp Psychiatry portalKraepelinian dichotomy Comparison of bipolar disorder and schizophrenia History of bipolar disorder History of schizophrenia Lunatic asylum Psychiatric hospitalReferences edit a b c d e f g h i j Dagmar Drull Heidelberger Gelehrtenlexikon 1803 1932 Springer Verlag 2013 p 149 a b c Engstrom E J 1 September 2007 On the Question of Degeneration by Emil Kraepelin 1908 1 PDF History of Psychiatry 18 3 389 398 doi 10 1177 0957154X07079689 PMID 18175639 S2CID 46482747 Archived from the original PDF on 26 May 2013 Shepherd M 1 August 1995 Two faces of Emil Kraepelin The British Journal of Psychiatry 167 2 174 183 doi 10 1192 bjp 167 2 174 PMID 7582666 S2CID 37204909 Peter Barham 2004 Forgotten Lunatics of the Great War New Haven Yale p 163 n 47 On Kraepelin s early life and family see Burgmair et al vol I as well as his Memoirs Berlin Springer 1987 a b c d e f g h Kraepelin Emil 1856 1926 by Margaret Alic Gale Encyclopedia of Psychology 2001 Klinik fur Psychiatrie und Psychotherapie Historie LMU Klinikum Munchen Retrieved 10 June 2021 See 1 German Society for Psychiatry Psychotherapy Psychosomatics and Neurology and 2 History of the DGPPN Burgmair Wolfgang and Matthias M Weber Das Geld ist gut angelegt und du brauchst keine Reue zu haben James Loeb ein deutsch amerikanischer Wissenschaftsmazen zwischen Kaiserreich und Weimarer Republik Historische Zeitschrift 277 2003 343 378 James Loeb Harvard University Press Hans C Bangen Geschichte der medikamentosen Therapie der Schizophrenie VWB Berlin 1992 ISBN 3 927408 82 4 a b Engstrom EJ Weber MM Burgmair W October 2006 Emil Wilhelm Magnus Georg Kraepelin 1856 1926 The American Journal of Psychiatry 163 10 1710 doi 10 1176 appi ajp 163 10 1710 PMID 17012678 Shepherd Michael 1990 Conceptual Issues in Psychological Medicine London Tavistock Routledge p 230 ISBN 978 0415165303 a b Decker Hannah S 2007 How Kraepelinian was Kraepelin How Kraepelinian are the neo Kraepelinians from Emil Kraepelin to DSM III PDF History of Psychiatry 18 3 337 360 doi 10 1177 0957154X07078976 PMID 18175636 S2CID 19754009 Archived from the original PDF on 29 October 2013 Teodoro T Durval R October 2022 Emil Kraepelin s taxonomic unitary view of manic depressive insanity in the 21st century the never ending diagnostic conundrum of bipolar depression CNS Spectrums 28 4 389 390 doi 10 1017 s109285292200102x PMID 36210529 S2CID 252779392 Yuhas Daisy March 2013 Throughout History Defining Schizophrenia Has Remained a Challenge Timeline Scientific American Mind March 2013 Retrieved 2 March 2013 Ebert Andreas 2010 Emil Kraepelin A pioneer of scientific understanding of psychiatry and psychopharmacology Indian Journal of Psychiatry 52 2 191 2 doi 10 4103 0019 5545 64591 PMC 2927892 PMID 20838510 Berrios GE Luque R Villagran JM 2003 Schizophrenia a conceptual history PDF International Journal of Psychology and Psychological Therapy 3 2 111 140 Noll Richard Whole Body Madness Psychiatric Times Retrieved 26 September 2012 a b Richard Wetzell 2000 Inventing the criminal a history of German criminology 1880 1945 from p 59 amp 146 misc Henning Sass amp Alan Felthous 2008 Chapter 1 History and Conceptual Development of Psychopathic Disorders in International Handbook on Psychopathic Disorders and the Law Edited by Alan Felthous Henning Sass Brune Martin 1 January 2007 On human self domestication psychiatry and eugenics Philosophy Ethics and Humanities in Medicine 2 1 21 doi 10 1186 1747 5341 2 21 PMC 2082022 PMID 17919321 Engstrom Eric J Weber Matthias 2007 Making Kraepelin History A Great Instauration Special Issue PDF History of Psychiatry 18 3 267 273 doi 10 1177 0957154x07080819 S2CID 144482013 Archived from the original PDF on 29 October 2013 Engstrom Eric J Organizing Psychiatric Research in Munich 1903 1925 A Psychiatric Zoon Politicon between State Bureaucracy and American Philanthropy In International Relations in Psychiatry Britain Germany and the United States through World War II edited by Volker Roelcke Paul J Weindling and Louise Westwood 48 66 Rochester University of Rochester Press 2010 Engstrom Eric Weber Matthias Burgmair Wolfgang 2016 Psychiatric Governance volkisch Corporatism and the German Research Institute for Psychiatry in Munich 1912 1926 History of Psychiatry 27 1 2 38 50 137 152 doi 10 1177 0957154x15623692 PMID 26823087 S2CID 21375412 Noll Richard The Bed Makes Gestures Psychiatric times Retrieved 8 February 2013 Uber Sprachstorungen im Traume 1906 Sources editNoll Richard 2011 American Madness The Rise and Fall of Dementia Praecox Cambridge and London Harvard University Press Briole G 2012 Emil Kraepelin The Fragility of a Colossal Oeuvre Hurly Burly 8 125 147 External links editExtensive bibliography of English translations of Kraepelin s works Extensive bibliography of works by and about Kraepelin s including those in the original German psych mpg de International Kraepelin Society contact Kraepelin s monograph Uber Sprachstorungen im Traume Octavian Buda The late works of Emil Kraepelin Goethe Institute Riga Latvia 7th May 2009 at the Wayback Machine archived 23 December 2019 Newspaper clippings about Emil Kraepelin in the 20th Century Press Archives of the ZBWFor biographies of Kraepelin see engstrom de KRAEPELINBIOGRAPHY pdf uni leipzig de psy eng kraep e html Burkhart Bruckner Julian Schwarz Biography of Emil Wilhelm Georg Magnus Kraepelin in Biographical Archive of Psychiatry BIAPSY For English translations of Kraepelin s work see On Uprootedness 1921 Emil Kraepelin s Clinical Self Assessment 1920 Psychiatric Observations on Contemporary Issues 1919 On the Question of Degeneration 1908 The Directions of Psychiatric Research 1887 Retrieved from https en wikipedia org w index php title Emil Kraepelin amp oldid 1193693704, wikipedia, wiki, book, books, library,

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