Prolegomenon to the Clinical Prerequisite; Psychopharmacology and the Classification of Mental Disorders
(Volume 1)

Conceptual Development of Current Psychiatric Nosology

Thomas A. Ban and Antonio Torrez Ruiz

Preface

In the absence of clearly identifiable morphological substrate by histological and/or neurochemical methods, there is no consensus in regard to the meaning of "disease entity" in relationship to mental illness. In spite of this, "psychiatric nosology," the discipline concerned with the classification of "disease entities" in psychiatry is well over 200 years old. It began in the mid-18th century with the work of Boissier de Sauvages (1768); developed during the early 19th century through the classifications of Pinel (1798) and Esquirol (1838) in France; and reached maturity in the classifications of Kraepelin (1896) in Germany and Bleuler (1916) in Switzerland.

The basic principles of "psychiatric nosology" were set out in Jaspers' classic text, General Psychopathology, first published in 1913. In his monumental work, Jaspers (1913, 1919, 1922, 1942, 1959, 1962) separated "nosography," the “case history," from "biography," the "life history” and defined "nosology" as the discipline concerned with the "synthesis of disease entities" primarily from "psychopathological phenomena." For Jaspers (1962) "the idea of the disease entity" was "an idea in Kant's sense of the word; the concept of an objective which one cannot reach since it is unending," but which "indicates the path for fruitful research and supplies a valid point of orientation for particular empirical investigations." He maintained that "in nosology we do not secure a single, definite disease-entity, but guided by the idea of disease-entity, we give preference to certain, particular elements and isolate for our diagnostic purposes the relative disease entities as best we can."

The notion of "relative disease entities" and the "conceptual continuum of disease entities" led to empirical studies. These, in turn, yielded to increasingly "more developed" disease pictures, such as the "psychopathological disease entity" of Pauleikhoff (1969), the "etiological-syndromatological disease entity" of Petho, Tolna and Tusnady (1979) and the "small disease entity" of Schneider (1925, 1932) (Petho et al., 1984). By rendering "relative disease entities "accessible for direct investigation, the detection of "natural disease- entities" and the development of a "valid nosology" have become distinct possibilities in psychiatry.

In the following Introduction to Psychiatric Nosology, the basic principles of psychiatric nosology will be discussed and the conceptual development of a new classification of mental disorders will be outlined.