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An historical framework for psychiatric nosology

  • K. S. Kendler (a1)

This essay, which seeks to provide an historical framework for our efforts to develop a scientific psychiatric nosology, begins by reviewing the classificatory approaches that arose in the early history of biological taxonomy. Initial attempts at species definition used top-down approaches advocated by experts and based on a few essential features of the organism chosen a priori. This approach was subsequently rejected on both conceptual and practical grounds and replaced by bottom-up approaches making use of a much wider array of features. Multiple parallels exist between the beginnings of biological taxonomy and psychiatric nosology. Like biological taxonomy, psychiatric nosology largely began with ‘expert’ classifications, typically influenced by a few essential features, articulated by one or more great 19th-century diagnosticians. Like biology, psychiatry is struggling toward more soundly based bottom-up approaches using diverse illness characteristics. The underemphasized historically contingent nature of our current psychiatric classification is illustrated by recounting the history of how ‘Schneiderian’ symptoms of schizophrenia entered into DSM-III. Given these historical contingencies, it is vital that our psychiatric nosologic enterprise be cumulative. This can be best achieved through a process of epistemic iteration. If we can develop a stable consensus in our theoretical orientation toward psychiatric illness, we can apply this approach, which has one crucial virtue. Regardless of the starting point, if each iteration (or revision) improves the performance of the nosology, the eventual success of the nosologic process, to optimally reflect the complex reality of psychiatric illness, is assured.

Corresponding author
*Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University Medical School, Box 980126, 800 E. Leigh Street, Room 1-123, Richmond, VA 23298-0126, USA. (Email:
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Bleuler E (1950). Dementia Praecox or the Group of Schizophrenias. International Universities Press: New York.
Chang H (2004). Inventing Temperature: Measurement and Scientific Progress. Oxford University Press: New York, NY.
Dear P (2006). The Intelligibility of Nature: How Science Makes Sense of the World. The University of Chicago Press: Chicago, IL.
Edgerton RB (1976). Deviance: A Cross-Cultural Perspective. Cummings Publishing Company, Inc.: Menlo Park, CA.
Feighner JP, Robins E, Guze SB, Woodruff RA Jr., Winokur G, Munoz R (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5763.
Hacking I (1998). Mad Travelers: Reflections on the Reality of Transient Mental Illnesses. University Press of Virginia: Charlottesville, VA.
Kendler KS (1990). Toward a scientific psychiatric nosology. Strengths and limitations. Archives of General Psychiatry 47, 969973.
Kendler KS, Parnas J (2008). Philosophical Issues in Psychiatry: Explanation, Phenomenology and Nosology. Johns Hopkins University Press: Baltimore, MD.
Kleinman A (2004). Culture and depression. New England Journal of Medicine 351, 951953.
Kraam A (2008). Karl Ludwig Kahlbaum by Dr. Ewald Hecker (1899). History of Psychiatry 19, 7780.
Kraepelin E (1987). Memoirs/Emil Kraepelin. Springer-Verlag: Berlin.
Kuhn TS (1996). The Structure of Scientific Revolutions. University of Chicago Press: Chicago, IL.
Locke J (1870). An Essay Concerning Human Understanding, 29th edn.Thomas Tegg: London.
Mayr E (1982). The Growth of Biological Thought. Belknap Press: Cambridge, MA.
Mellor CS (1970). First rank symptoms of schizophrenia. I. The frequency in schizophrenics on admission to hospital. II. Differences between individual first rank symptoms. British Journal of Psychiatry 117, 1523.
Menezes NM, Arenovich T, Zipursky RB (2006). A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36, 13491362.
Murphy JM (1976). Psychiatric labeling in cross-cultural perspective. Science 191, 10191028.
Shorter E (2005). A Historical Dictionary of Psychiatry. Oxford University Press: New York, NY.
Sloan PR (1972). John Locke, John Ray, and the problem of the natural system. Journal of the History of Biology 5, 153.
Spitzer RL, Endicott J, Robins E (1975). Research Diagnostic Criteria for a Selected Group of Functional Disorders. New York Psychiatric Institute: New York.
Spitzer RL, Endicott J, Robins E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.
Westermeyer J (1979). Folk concepts of mental disorder among the Lao: continuities with similar concepts in other cultures and in psychiatry. Cultural and Medical Psychiatry 3, 301317.
Wikipedia (2008). Kurt Schneider. In Wikipedia, The Free Encyclopedia ( Accessed 2 July 2008.
Wing JK, Birley JL, Cooper JE, Graham P, Isaacs AD (1967). Reliability of a procedure for measuring and classifying ‘present psychiatric state’. British Journal of Psychiatry 113, 499515.
Zilboorg G (1967). A History of Medical Psychology. New York: W. W. Norton & Company.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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