On the Origin of the Clinical Standpoint in Psychiatry

Ewald Hecker (1843-1909), a friend and disciple of Karl Ludwig Kahlbaum (1828-1899), was a relentless advocate of his teacher’s psychiatric nosology. This paper is an early manifesto of their ideas and sets the context for the following publications, namely Hecker’s seminal paper on hebephrenia to be published in the same journal and in the same year (1871) and Kahlbaum’s catatonia published in 1874. Their idea that age of onset and time course of an illness, together with close clinical observation, helps to delineate disease forms out of the mass of confusing psychiatric symptoms proved to be one of the most important paradigm shifts in middle to late nineteenth-century psychiatry. This had a strong influence on Kraepelin’s dichotomy between dementia praecox and manic depressive insanity, and thus on our modern notions of schizophrenia and bipolar illness.