An Experiential Approach to Psychopathology: What is it like to Suffer from Mental Disorders? PDF
Preview An Experiential Approach to Psychopathology: What is it like to Suffer from Mental Disorders?
An Experiential Approach to Psychopathology What is it like to Suff er from Mental Disorders? Giovanni Stanghellini Massimiliano Aragona Editors 123 An Experiential Approach to Psychopathology ThiSisaFMBlankPage Giovanni Stanghellini (cid:129) Massimiliano Aragona Editors An Experiential Approach to Psychopathology What is it like to Suffer from Mental Disorders? Editors GiovanniStanghellini MassimilianoAragona DepartmentofPsychological,Humanistic SapienzaUniversityandCrossing andTerritorialSciences DialoguesAssociation ‘G.d’Annunzio’University Rome,Italy Chieti,Italy ‘D.Portales’University Santiago,Chile ISBN978-3-319-29943-3 ISBN978-3-319-29945-7 (eBook) DOI10.1007/978-3-319-29945-7 LibraryofCongressControlNumber:2016942539 #SpringerInternationalPublishingSwitzerland2016 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodologynowknownorhereafterdeveloped. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Thepublisher,theauthorsandtheeditorsaresafetoassumethattheadviceandinformationinthis book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained hereinorforanyerrorsoromissionsthatmayhavebeenmade. Printedonacid-freepaper ThisSpringerimprintispublishedbySpringerNature TheregisteredcompanyisSpringerInternationalPublishingAGSwitzerland Contents 1 PhenomenologicalPsychopathology:TowardaPerson-Centered HermeneuticApproachintheClinicalEncounter. . . . . . . . . . . . . 1 GiovanniStanghelliniandMassimilianoAragona 2 PhenomenologicalInvestigationofObsessive-Compulsive Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 MartinB€urgy 3 TheWindowandtheWound:DysphoriaandAnger inBorderlineDisorders. . . . .. . . . . .. . . . .. . . . . .. . . . . .. . . . .. 61 MarioRossiMonti 4 GenderDysphoria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 GiovanniCastellini 5 AnExperientialApproachtoDissociativePhenomena. . . . . . . . . . 97 LuisMadeiraandMariaLuisaFigueira 6 VarietiesofMind-BodyDisunity. . . . . . . . . . . . . . . . . . . . . . . . . . . 113 RobertD.StolorowandGeorgeE.Atwood 7 AnorexiaNervosa:Historical,Clinical,Biographical, andPhenomenologicalConsiderations. . . . . . . . . . . . . . . . . . . . . . 127 OttoDoerr-ZegersandHe´ctorPelegrina-Cetra´n 8 Alcohol-InducedPsychoticDisorders. . . . . . . . . . . . . . . . . . . . . . . 149 M.Musalek,O.Scheibenbogen,andA.Schuster 9 “SyntheticPsychosis”byNovelPsychoactiveSubstances: APsychopathologicalUnderstandingofaClinicalCase. . . . . . . . . 163 G.DiPetta 10 MelancholiafromthePerspectiveoftheSelf. . . . . . . . . . . . . . . . . 189 AlfredKraus 11 ThePhenomenologicalApproachtoPatientswithBizarreness. . . . 221 GarethS.Owen v vi Contents 12 CapgrasSyndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 FemiOyebode 13 Perplexity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 ClaraS.HumpstonandMatthewR.Broome 14 Self-DisordersinSchizophrenia. . . . . . . . . . . . . . . . . . . . . . . . . . . 265 MadsGramHenriksenandJulieNordgaard 15 AutisminSchizophrenia:APhenomenologicalStudy. . . . . . . . . . . 281 MassimoBallerini 16 Hallucination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 J.Cutting 17 FearandTrembling:ACaseStudyofVoiceHearing inSchizophreniaasaSelf-Disorder. . . . . . . . . . . . . . . . . . . . . . . . 317 MarinoPe´rez-A´lvarez,OscarVallina-Ferna´ndez, Jose´ M.Garc´ıa-Montes,andLouisA.Sass 18 Catatonia—Phenomenology,Psychopathology, andPathophysiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 GeorgNorthoff 19 PainfulAffectintheExperienceandTreatment ofSchizophrenia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 JayA.HammandPaulH.Lysaker 20 PhenomenologicalPsychopathologyandCare. FromPerson-CenteredDialecticalPsychopathology tothePHDMethodforPsychotherapy. . . . . . . . . . . . . . . . . . . . . . 361 GiovanniStanghellini Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 1 Phenomenological Psychopathology: Toward a Person-Centered Hermeneutic Approach in the Clinical Encounter Giovanni Stanghellini and Massimiliano Aragona This introduction is an overall outlook of the methods used in phenomenological psychopathology. The several meanings of the term ‘psychopathology’ are differentiated, together with a brief overview of the main ideas in philosophical phenomenology. Then, the principal methodological concepts in use in phenome- nologicalpsychopathologyarediscussed:formandcontent,explainingandunder- standing, static and genetic understanding, epoche´ and eidos, the existentialia exploringthebasicwayhumanbeingsexistintheworld.Finally,thehermeneutic approach in psychopathology is discussed at three levels: the hermeneutics of mental symptoms, the hermeneutic circle in the relationship between symptoms anddiagnosis,andthehermeneuticsofthedeepsubjectivestructureonwhich the previouslevelsaregrounded. 1.1 Psychopathology as the Basic Science for Mental Health Care Abookofphenomenologicalpsychopathologyfirstlyneeds todefine exactlyhow the two key terms (“phenomenology” and “psychopathology”) will be intended. This is because scholars use them differently in different contexts. Accordingly, G.Stanghellini DepartmentofPsychological,HumanisticandTerritorialSciences,‘G.d’Annunzio’University, Chieti,Italy “D.Portales”University,Santiago,Chile e-mail:[email protected] M.Aragona(*) ‘D.Portales’University,Santiago,Chile e-mail:[email protected] #SpringerInternationalPublishingSwitzerland2016 1 G.Stanghellini,M.Aragona(eds.),AnExperientialApproachtoPsychopathology, DOI10.1007/978-3-319-29945-7_1 2 G.StanghelliniandM.Aragona someterminologicalclarificationisusefultoavoidpossiblemisunderstandings.So thefirstquestionis:WhatisPsychopathology? In many instances, this word is used as a synonym for “mental symptom,” “mental syndrome,” “mental disorder,” and the like. For example, the reader of a paper entitled “Psychopathology in Multiple Sclerosis” can reasonably expect to find there the assessment (usually by means of “rating scales”) of a more or less largearrayofmentalsymptoms,likedepression,anxiety,andsoon.Thisuseofthe wordpsychopathologyisverygeneraland,althoughacceptable,addsnothingtothe information transmitted by the use of more specific names for individual mental symptomsand/ordisorders. Incontrasttothisverygeneraluse, inwhich psychopathologyisdefined byits focus on some “pathological” mental contents and abnormal expressions and behaviors, in all other cases psychopathology is conceived as a method or a discipline. Such a shift from content to method is best illustrated by the focus on methodologicalawarenessinKarlJaspers’GeneralPsychopathology(1963,p.5): “Ifwewishtoraiseourstatementsanddiscoveriestofirmground,abovethedaily flood of psychological notions, we shall almost always beforced toreflecton our methodology.” Starting from this common ground, different emphases explain furthervariationintheuseofthesameword. In a second, very common usage, the term “psychopathology” refers to the purely descriptive study of mental symptoms. More specifically, the method employed to study mental symptoms, their formal features allowing a distinction fromsimilarphenomena.Descriptivepsychopathologyisthecommonlanguageor koine´thatallowsspecialistseachspeakingtheirowndialectorjargontounderstand each other. Its “breeding ground” is the work of Karl Jaspers and the Heidelberg School(Janzarik1976).Descriptivepsychopathologygivesaconcretedescription of the psychic states which patients actually experience; it delineates and differentiates them as sharply as possible; and it creates a suitable terminology (Jaspers1963,p.55).Itisquintessentialinrecognizingandnamingtheabnormalor pathologicalphenomenathataffectthehumanmind.Themainobjectsofdescrip- tive psychopathology are the patients’ experiences. The form in which these experiences are presented is considered more significant than their contents. Perceptions, ideas, judgments, feelings, drives, and self-awareness are all forms ofpsychicphenomena,denotingtheparticularmodeofexistenceinwhichacontent ispresentedtous. A third psychopathological approach derives directly from such a descriptive psychopathology,consideringthesignificanceoftheenucleatedphenomenawithin the psychiatric diagnosis and classification. In this context, the study of isolated symptomsshallallowtheidentificationofspecificdiagnosticentitiesthat,inturn, enablepredictionofnaturalhistoryandresponsetotreatment.Thisuseofpsycho- pathology as the tool for nosographic diagnosis is well illustrated by Kurt Schneider’s Clinical Psychopathology (1975), where the thorough descriptive characterization of mental symptoms makes possible the differential diagnosis betweenmentalpathologies. 1 PhenomenologicalPsychopathology:TowardaPerson-CenteredHermeneutic... 3 Itshouldbestressedthatalthoughpsychopathologyisaboutallthat,itisnotjust aboutthat.Infact,thefocusonapurelydescriptivepsychopathologyisprimafacie in line with the biomedical approach that looks for the formalization of good explananda,i.e.,symptomsanddiagnosesintendedasnaturalentitiestobereduced andreconceivedaseffectsofsomesupposedunderlying(neuro)biologicaldysfunc- tionwhichexplainsthem.Apsychopathologicalapproachdoesnotexcludeseeing mental symptoms and disorders as caused by possible dysfunctions to be cured (Jaspershimselfclearlywrotethattheuseoftheexplanatorymethodisadmissible, coherent,andpotentiallyunlimited:Jaspers1963).However,thepsychopathologist isalsowellawarethatbyreducingacomplainttoasymptomofadysfunction,we unavoidablyovershadowthefactthatacomplainthasameaningfortheindividual sufferer. Moreover, if psychopathology is conflated with nosography, only those symptoms that are supposed to have diagnostic value will be investigated, thus loosingrelevantinformationthatisnotalreadyclassified.Accordingly,thefocuson theexplanationofmentalsymptomsandondiagnosisdiscouragesattentiontoreal people’s experiences. Whereas symptomatology and nosology are strictly illness oriented,psychopathologyisalsopersonoriented,sinceitattemptstodescribethe patient’s experience and his/her relationship to himself/herself and to the world. Thisleadsustothelasttwowaystointendthetermpsychopathology. Thefourthwaytousetheworldpsychopathologytakesintoaccountthesubjec- tive experience of the patient as it can be re-experienced by an empathic listener. This roughly corresponds to Jaspers’ use of the word “phenomenology.” This is, first and foremost, the meaning of psychopathology that inspires this book—the explorationoftheexperientialorpersonaldimensionofmentalpathologyor“what isitlike”tosufferforagivenmentaldisorder.Itsprincipalpurposeisunderstand- ing. The patients’ subjective experience is the “object” of this practice. Mental disordersareapparentintherealmofhumansubjectivityasabnormal,skewed,or constrainedexperiences,expressions,andbehaviors.Thisishowmentaldisorderis presentedtous.Mentaldisordersarefirstofallmental.Apathologyofthepsyche constitutes an experienced condition and a family of behaviors, feelings, and conscious contents, the peculiar significance of which emerges within a personal existence and history, and a sociocultural context. Such a kind of pathology is, therefore,completelyonviewonlybecauseofwhathasbeencalled“thepersonal levelofanalysis”(Hornsby2000;Gabbani&Stanghellini2008).Onlyatthislevel, indeed, thereal correlatesofapsychopathologicalcondition canbeunderstoodin their peculiar feel, meaning, and value for the subjects affected by them (Stanghellini 2007). The comprehension of the pathological significance of a psychic state (i.e., its meaning in a personal life) requires a kind of analysis which exceeds the range of a naturalistic approach. What one sees physically may be changes in receptor function, neurotransmitter metabolism, or whatever. Butsuch changes cannotbediagnosedas“disordered”inandofthemselves:they require mental abnormalities to be detected. The norm at play here is first and foremostatthementallevel.Thepointhereisthatmentaldisordersappearonthe personal level. Subpersonal abnormalities are only picked out as such by the person-level experience of disorder. The altered level of dopamine release would
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