The Continuum of Psychosis — 1986 - 2010

The shadow of Kraepelin stands over psychosis nosology like a colossus. The reason is that Kraepelin made an attempt to systematize diagnosis in a rational, pathophysiological manner. But, to this day, no one has done better. The tragedy is that one can say of Kraepelin that the measure of his stature is the extent to which his infl uence has delayed progress since his death. With such a judgment, we may be sure he would be distressed. By 1920, he had formulated reservations about the dichotomous scheme to which his name is attached. The quotation that summarizes the paper is: “No experienced psychiatrist will deny that there is an alarmingly large number of cases in which it seems impossible, in spite of the most careful observation, to make a fi rm diagnosis ... Nevertheless it is becoming increasingly clear that we cannot distinguish satisfactorily between these two illnesses and this brings home the suspicion that our formulation of the problem may be incorrect ...”1 Timothy J. Crow, MBBS, PhD, FRCP, FRCPsych, FMedSci, is with SANE Prince of Wales International Centre, University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom. Address correspondence to: Timothy J. Crow, SANE Prince of Wales International Centre, University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK; or e-mail [email protected]. Dr. Crow has disclosed no relevant fi nancial relationships. doi: 10.3928/00485718-20100127-08