Stage Theory and the Kraepelinian Straightjacket

This chapter introduces the concept of “stage theory,” a phrase that would have been perfectly familiar to the pre-Kraepelinian psychiatrists (pre-1900) but which they did not articulate in that exact term. The concept of “staging” has been imported into psychiatry to mean, as in medicine, degree of severity of illness. In this chapter, the author proposes a slightly different use of the term: progression from one disease picture to another in a linear progression of pictures. What is the relevance today of these forgotten doctrines? It is that stage theory challenges the “present-phenomenology” approach to making the diagnosis. If some underlying train of events is the real illness, then “depression” and “psychosis” are only epiphenomena. By contrast, in DSM, the experience of patients is sorted into watertight compartments. It is possible that the palpable distaste for the whole DSM consensus-based system of classification may further kindle these sparks.