Oskar Panizza, M.D. (1853–1921): The Patient Behind Emil Kraepelin’s Concept of Paraphrenias

A contemporary of Kraepelin, Oskar Panizza, M.D. was a psychiatric trainee in Munich at the psychiatric hospital Oberbayerische Kreisirrenanstalt; he became psychotic while participating in Bernhard von Gudden’s famous degeneration studies. He felt as if his brain were cut in slices and watched under a microscope. Panizza tried to cope with his psychotic episodes by publishing literary works. Most of his work was confiscated because of its lurid contents, and Panizza was even sentenced to prison for 1 year. Released in 1896, he went to Switzerland and became a publisher, outlining ideas that anticipated the antipsychiatry movement of the 1960s and 1970s. In 1898, Panizza was deported from Switzerland and went to Paris. In France he felt persecuted by the German Emperor Wilhelm II and tried to fight him by his poetry. Charged with lèse-majesté because of his work “Parisiana,” Panizza finally gave himself up to the German authorities. Back in the psychiatric hospital in Munich, he was given the diagnosis of paranoia. Thereafter, Panizza lived again in Paris, suffering from Capgras syndrome and tortured by acoustic and olfactory hallucinations and cenesthetic symptoms. In 1904, Panizza fled from Paris to the psychiatric hospital in Munich, where Kraepelin had become chief of the department in 1903. At this time Kraepelin’s binary system of dementia praecox or circuläres Irresein was contested, and Panizza himself became a personification of the insufficiencies of Kraepelin’s system, leading ultimately to the concept of paraphrenias. In 1921, for the first time, the eighth edition of Kraepelin’s textbook of psychiatry contained the concept of paraphrenias. “Systematic paraphrenia” was mentioned in a lecture given in 1916 (in the third edition of Kraepelin’s lectures), and Oskar Panizza’s history was used as a case report. After 1905, Panizza lived incapacitated in Bayreuth, where he suffered from a stroke and died in 1921.