Response to Strous et al.: A Focus on Kraepelin’s Clinical Research Methodology

To the Editor: The letter is correct in claiming that we do not treat these issues in this particular article. But that is simply because we were addressing an altogether different aspect of Kraepelin’s work; that is, his clinical research methodology. To have broached the issues mentioned in the letter would have distracted us from our main argument and burdened us with the impossible task of doing justice to the very complex relationship between eugenic practices—which were commonplace in Germany, the United States, and elsewhere in Kraepelin’s time—and Nazi policies of extermination. This relationship has been the subject of numerous prior articles. Do the authors wish to claim that any discussion of Kraepelin’s work needs to review these issues? This seems to us to be a hard argument to sustain.

Second, the letter argues implicitly that Kraepelin should be held accountable for the actions of his mentees. That is a bold claim that we believe would be hard to defend if carried out systematically for all major figures in science, history, literature, and politics. The letter cites a number of Kraepelin’s students (Gaupp, Nitsche, Rüdin) and colleagues (Hoche). Certainly, these individuals were inspired by Kraepelin’s writings. But the suggestion that their views can be attributed one-to-one to Kraepelin’s nosology is simply incorrect. Gaupp, Nitsche, and Rüdin shared very different views about racial hygiene. Gaupp in particular was a eugenicist but was in no way involved in Nazi extermination policies. Furthermore, nowhere in Kraepelin’s writings will one find any endorsement of euthanasia. To suggest as the letter does that Kraepelin was effectively a proponent of genocidal policies is simply false. These are extraordinarily complex historical issues, but there simply is no direct link between Kraepelin and his mentees when it comes to genocidal policies and to “exterminatory” forms of anti-Semitism.

Third, and perhaps most fundamentally, does this letter add to the historical scholarship that we were trying to address in our essay? We do not argue that these questions are unimportant or that they do not deserve on their own merits attention in the psychiatric literature. Our argument is a more limited one. These questions are not germane to the topic of our article. They do not augment the level of scholarly discourse on the issues we raised: Kraepelin’s clinical research program and his relationship with psychology, on the one hand, and brain science (circa the 1890s in Germany) on the other. We object to the implication that we are morally responsible to raise these issues in our article about a quite different aspect of Kraepelin’s career, especially in light of the extensive treatment of exactly these questions in many other publications, a number of which are from one of us (E.J.E.) (1–3). Shepherd’s entire article (4) is based on the translation of “Psychiatric Observations on Contemporary Issues” (5) that E.J.E. published decades ago. Furthermore, Mildenberger’s article (6) is published in a volume of which E.J.E. was the editor. E.J.E. also addressed Kraepelin’s views on degeneration theory in another publication (“‘On the question of degeneration’ by Emil Kraepelin (1908)”) (7) that the authors do not cite. In addition, the authors should note that both volumes 7 and 8 of the Kraepelin Edition (8, 9) (of which E.J.E. is one of the editors) address Kraepelin’s eugenic and racial hygienic views as well as his occasional anti-Semitic and racist remarks.