Karl Kahlbaum

In 1874, Karl Kahlbaum, a German psychiatrist in an obscure private hospital, pulled various symptom pictures together into a single diagnosis: “catatonia.” Kahlbaum had earlier pioneered the modern classification of illness with his concepts of course and outcome as demarcating the various disease entities. He thought that, similar to neurosyphilis, catatonia had a common cause and common clinical course but, unlike neurosyphilis, often a relatively benign outcome. He believed the illness progressed in fixed stages. At the same time, Kahlbaum’s associate, Ewald Hecker, described madness in young people (“hebephrenia”), which became the forbearer of “schizophrenia.” Kahlbaum’s ideas were not immediately accepted: there was a core of true believers, but many psychiatrists in the Atlantic community did not readily take up the diagnosis and remained skeptical that Kahlbaum had done anything other than repackage familiar symptoms in a new and unfamiliar box.