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La schizophrénie. Psychopathologie des schizoides et des schizophrènes. / Schizophrenia. Psychopathology of schizoids and schizophrenics.
Abstract
Schizophrenia, one of the most important chapters in modern psychiatry, has sensibly modified the manner of interpreting mental troubles and given a new impulse to psychopathological investigations. The leading ideas which are evolved from this notion bring forward new data concerning human activity in general. Sprung from the investigations by Kraepelin about dementia praecox and influenced on the other hand by the conceptions of Freud, the notion of schizophrenia acquires more and more independence. It finally arrives closer and closer to the study of the phenomena of the normal life. Under the influence of the Bergsonian ideas, the notion of the loss of vital contact with reality becames the central point of the psychopathology of schizophrenics. The peculiarities of schizophrenic thought, the reactions of emotional order coming unexpectedly with schizophrenics in the form of an attitude of revery, of pouting, autism, the rôle of the affective factors in the pathogeny of symptoms, all are to be examined from such a point of view. A classification of different forms of schizophrenia is also derived therefrom. The notion of schizophrenia, in the domain of psychological constitutions, borders upon the fertile notion of schizoidy which has in view the characteristic behavior of the individual to the environment. No bibliography. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The schizophrenic is he or she who is overly liable to evaluate their situation within a metaphysical, scientific or artistic paradigm. There is a considerable literature supporting this, from Minkowski's (1927Minkowski's ( /1987 observations through to the vignettes on the matter provided by Naudin et al. (2000). What is not so well appreciated is that the loose collection of areas in which the schizophrenic exhibits compromised knowledge -known in mainstream psychiatry as negative symptoms and variously formulated within psychopathology as 'lack of common sense' (Blankenburg, 1969(Blankenburg, /2001 or a 'loss of vital contact with reality' (Minkowski, 1927(Minkowski, /1987) -is best seen as de-valuations or mis-valuations of a whole region of values open to the human being. ...
... The schizophrenic is he or she who is overly liable to evaluate their situation within a metaphysical, scientific or artistic paradigm. There is a considerable literature supporting this, from Minkowski's (1927Minkowski's ( /1987 observations through to the vignettes on the matter provided by Naudin et al. (2000). What is not so well appreciated is that the loose collection of areas in which the schizophrenic exhibits compromised knowledge -known in mainstream psychiatry as negative symptoms and variously formulated within psychopathology as 'lack of common sense' (Blankenburg, 1969(Blankenburg, /2001 or a 'loss of vital contact with reality' (Minkowski, 1927(Minkowski, /1987) -is best seen as de-valuations or mis-valuations of a whole region of values open to the human being. ...
... There is a considerable literature supporting this, from Minkowski's (1927Minkowski's ( /1987 observations through to the vignettes on the matter provided by Naudin et al. (2000). What is not so well appreciated is that the loose collection of areas in which the schizophrenic exhibits compromised knowledge -known in mainstream psychiatry as negative symptoms and variously formulated within psychopathology as 'lack of common sense' (Blankenburg, 1969(Blankenburg, /2001 or a 'loss of vital contact with reality' (Minkowski, 1927(Minkowski, /1987) -is best seen as de-valuations or mis-valuations of a whole region of values open to the human being. Minkowski's core psychopathological insight about schizophrenia would carry more weight, in my view, if he had framed it within Scheler's scheme of values. ...
The philosopher Max Scheler (1874-1928) set out a hierarchical theory of values and emotions in the early twentieth century. This inspired Kurt Schneider to distinguish two sorts of depressive illness, each conforming to aStörung(disorder) in different levels of Scheler's hierarchy. No other psychopathologist, except Stanghellini, gave the matter much attention. I believe that Scheler's theory is a rich source of insight into psychopathology, general and neuropsychiatric. I therefore give an account of Scheler's scheme, review its extant applications (Schneider's, Stanghellini's), and present suggestions as to its continuing potential relevance in a wide range of psychopathological conditions.
... Phenomenology was used only sparingly by psychopathologists in the half-century following Jaspers (with some exceptions, e.g., Minkowski, 1927Minkowski, /1953. However, in the late-20th century, a growing number of phenomenologists attempted to elucidate the presumed core features of psychotic experience in ways that might, they hoped, render schizophrenia intelligible. ...
... Yet many of these accounts posited experiential and life-historical explications of the intersubjective chasm believed to characterize the conditions. For example, French psychiatrist Minkowski (1927Minkowski ( /1953 claimed that the essence of schizophrenia, which he called the "trouble générateur," was the loss of "vital contact with reality" (VCR), a reversal of interiority and exteriority that resulted in a putatively autistic relationship with the surrounding world (see Urfer, 2001). Likewise, German psychiatrist Blankenburg (1971Blankenburg ( , 1969Blankenburg ( /2001) posited that schizophrenia is characterized by the loss of "natural self-evidence" (Selbstverstandlichkeit) or a "common-sense" orientation toward the world. ...
Do psychiatry and clinical psychology have an “other”? This article critically addresses the clinical-scientific fascination with diagnostic challenges and other psychiatric mysteries, focusing on the example of “schizophrenia,” often seen as the most severe and enigmatic of all mental disorders. Over a century of clinical and scientific discourse on schizophrenia has painted a portrait of something indecipherable at the very foundation of psychiatric inquiry. Despite entrenched beliefs, mounting evidence from both qualitative-phenomenological and quantitative research suggests that the experience of psychosis can be meaningfully understood. Further, there is a wealth of data indicating that persons with lived experience of psychosis can lead self-actualized lives, and new studies have revealed that psychotic experiences are common in non-clinical populations. Yet traditional views of psychosis persist in the face of this mounting evidence. I suggest that the key to de-othering schizophrenia may lie in an emerging body of research on “social defeat,” marginalization, and alienation. More specifically, the experiences and behaviors commonly designated as psychosis arise in social and interpersonal contexts that are distinctly alienating, including the psychiatric encounter. It follows that schizophrenia may not be the elusive empirical object of debates about unintelligibility or “ununderstandability,” but rather a social configuration that is manifest within the deadlock of this debate itself.
... 63). The re-elaboration of this concept by Minkowski [30] makes even more evident its connection with Rümke's thinking. Minkowski, in fact, prefers the definition of "loss of vital contact with reality" to that of "autism," claiming that the generating disorder (trouble générateur) of schizophrenia is not simply a withdrawal into solitude or a pathological inclination to inner life, but rather a disruption in the basic human ability to prereflectively attune with the external world. ...
... On the one hand, there is the psychoanalytic reflection on the transference-countertransference dynamics, which, beyond its primarily belonging to the psychotherapeutic process, should be considered also by psychiatrists as a potentially discriminating factor in the patient's evaluation [44,45]. On the other hand, there are the contributions coming from classical psychopathologists in the field of the diagnostic intuitive or empathic processes [29,30,46,47], some of which have been introduced in this paper. A further examination of these conceptualizations, however, goes beyond the purpose of our discourse, and it can be referred to the recent literature on the subject [19-21, 43, 48, 49]. ...
Despite the development and widespread diffusion of mod-
ern nosographic systems, the diagnosis of schizophrenia
continues to raise several epistemological issues. To address
these issues, a number of researchers are currently pursuing
the possibility of an integration between reliable, objective
approaches and the intersubjective perspective in the clini-
cal encounter. In the present article, we discuss Rümke’s
popular concept of praecox feeling, as introduced in 1941
and re-elaborated over the following 20 years. Our aim was
to thoroughly analyze the author’s original formulation and
to identify the connections between his thinking and certain
psychopathological developments, epistemological issues,
and research perspectives on schizophrenia. The praecox
feeling is presented by Rümke as a sensitive diagnostic tool
for schizophrenia that is rooted in the peculiar subjective ex-
perience of the clinician when encountering a schizophrenic
patient. This experience seems to be characterized by two
essential dimensions: a subjective one, which reflects the
failure of a clinician’s empathic effort due to a fundamental
alteration of the intersubjective space, a phenomenon re-
lated to schizophrenic autism, and a gestaltic, objective one,
which is grounded in the clinician’s implicit typifying process
as a consequence of collecting recurrent clinical observa-
tions over the course of his/her professional experience. Ac-
cording to Rümke, the diagnostic use of the praecox feeling
should be limited to the acute phases of the schizophrenic
process, as the clinician’s experience of an intersubjective
struggle is attenuated in interactions with older, chronic pa-
tients. The multifaceted nature of Rümke’s proposal seems
to have contributed to some theoretical critiques and to in-
conclusive results from empirical investigations, leading to a
progressive devaluation of the scientific and diagnostic va-
lidity of praecox feeling. The present analysis of the original
concept suggests that a renewed research interest in the
role of the clinician’s subjective experience with regard to
the schizophrenic patient could be helpful.
... Although disturbances of subjective time perception have been clinically described in schizophrenia for a long time and are considered as a main feature of the pathology (Minkowski, 1927(Minkowski, , 1933, subjective TD has not yet been studied in schizophrenia. Our study sets out to investigate whether patients with schizophrenia have distorted perception of the subjective TD of recalled personal events, in addition to their impaired conscious recollection. ...
... The amount of detail (global MCQ score, temporal and non-temporal MCQ sub-scores) in patients' memories was not significantly correlated with the subjective TD of events. We argue that this lack of detail, temporal or non-temporal, represents probably one explanation for the distorted subjective time perception that has long been observed in schizophrenia (Minkowski, 1927(Minkowski, , 1933 and to the best of our knowledge, our study is the first to demonstrate this. The lack of detail, including perceptual, sensory, contextual, temporal and emotional details and other salient information that gives an event its uniqueness, results in deficient construction of mental representations of events in patients with schizophrenia (Danion et al., 2005Elvevåg et al., 2003;Neumann et al., 2007). ...
Disturbances of perception of subjective time have been described in schizophrenia but have not been experimentally studied until now. We investigated how patients with schizophrenia estimate the subjective temporal distance (TD) of past personal events, i.e. how these events are perceived as subjectively close or distant in time. Twenty-five patients with schizophrenia and 25 control participants recalled 24 autobiographical memories from four different life periods. They estimated the subjective TD and rated the amount of detail of each memory. Results showed that patients with schizophrenia had a distorted perception of subjective TD. Their memories were significantly less detailed than those of controls and, unlike control participants, the amount of memory detail was not significantly correlated with subjective TD. Poor access to memory detail may account for distortions of perception of subjective time in patients with schizophrenia.
... The deluded person over-identifies himself with his aberrant role. On the contrary, in the case of the shizo-hebephrenic disorder of the self, described by Minkovski (1927) and Parnas (2011), this thing is not possible any more. That is why the schizophrenic delusion is bizarre and depersonalizant. ...
The paper develops the idea of interpreting delusion based on Gallagher's “multiple realities” perspective. The self is considered to be permanently involved in different scenarios, including fictional ones, such as watching a play or reading a novel. The narrative theories of personality also discuss the involvement of the self in various scenarios, but with the possibility of returning to its basic, biographical identity. Delusion is interpreted as a “fall” in a role of an aberrant scenario, which the subject cannot escape from. The multiple realities are discussed from Mircea Eliade's perspective regarding the sacral time of the myth that forms the background for the time and structure of the fictional narratives. The normal psyche is characterized by a meta-representational structure, which allows the self to play the roles in different life scenarios. Delusion is interpreted as the alteration of the “autonoetic consciousness” and of the “mental time travel” structure.
... En conclusion de sa monographie Bosch retient comme signature de l'autisme la définition suivante : « L'autisme infantile est un état de faiblesse congénital ou précocement acquis esthétique-physiognomique et pragmatique . ». Ainsi formulée, on comprend d'emblée que cette définition plutôt obscure ait été retenue par Minkowski dans la schizophrénie (Minkowski, 1927)… Il est, de plus, regrettable que Bosch n'explicite pas ces concepts qui sont reliés pour le domaine esthétique-physiognomique aux travaux phénoménologiques de Zutt (Tatossian, 1997), psychiatre et phénoménologue et pour le domaine pragmatique aux écrits de Ortega y Gasset (Ortega Y Gasset, 1962). Le domaine esthétiquephysiognomique est défini par opposition au domaine affectif ; il correspond au corps tel qu'il apparaît subjectivement à travers le prisme sensoriel et le mouvement. ...
Dès les descriptions princeps des Troubles du Spectre de l’Autisme (TSA), l’accent a été mis sur les perturbations de l’identité subjective qu’il est possible d’étudier grâce à la conceptualisation de Conway qui fait interagir le self et la mémoire autobiographique. En nous basant sur ce modèle, nous avons exploré les spécificités du self dans les TSA Sans Déficience Intellectuelle (TSASDI) à travers l’étude de ses dimensions subjectives, conceptuelles et structurelles. Nos résultats retrouvent une atteinte du self au niveau structurel mais pas conceptuel ou subjectif. De plus, nous avons montré une atteinte de la fonction sociale de la mémoire autobiographique et que les images de soi sociales appartenant au self étaient associées à des souvenirs qualitativement différents. Nos résultats nuancent l’altération de la composante épisodique de la mémoire autobiographique et invitent à préciser l’influence des relations sociales sur le self et la mémoire autobiographique dans ces troubles.
... The importance of the psychiatrist's intuition and feeling of the clinical situation had been stressed in classical phenomenological psychopathological studies (Jaspers, 1913;Minkowski, 1927;Rümke, 1941), and its contribution to the diagnostic process has not ceased to be an object for debates (Kraus, 2002;Srivastava & Grube, 2009). Many studies highlight the fact that while dealing with the most tangled and complicated cases, instead of interfering with the diagnostic process, the psychiatrist's emotional response to the situation is often her main guide. ...
Based on the idea of objectivity as “a view
from nowhere,” the dominant approach to the subjectivity
of the clinician in psychiatry is a negative one: it
stipulates that the psychiatrist’s impressions and emotions
may only interfere with the results of the psychiatric
examination. Even the person-centered approach in
psychiatry fails to address this issue directly because it
focuses almost exclusively on the person of the patient.
A positive approach has only been adopted in psychotherapy
and in particular in psychoanalysis where the
clinician’s reaction to her client constitutes a rich source
of information about the client’s state. A positive attitude
to the clinician’s subjective experience can also be
found in phenomenologically informed psychopathological
and psychotherapeutic literature. Nevertheless, very
few researchers studied this topic thoroughly. In this
article, I explain this lack of interest and show that the
challenges for developing a phenomenological approach
stem not only from the epistemological presuppositions
of classic psychiatry, but also from the methodology of
classic phenomenological psychopathology that tends to
downplay the performative aspect of phenomenology.
I suggest that, when understood, instead, as a practice,
phenomenology offers the psychiatrist the tools to become
aware of her own lived experience of the clinical
encounter in a very specific way. After highlighting how
such a phenomenological awareness differs from the
psychoanalytical one, I argue that it allows reassessing
the idea of objectivity as “the view from nowhere” on
new grounds by demonstrating the embodied nature of
the subject of study.
... O que a psicose é na intersubjetividade do encontro, a fenomenologia dá aos práticos as palavras mais justas para dizê-lo. O "sentimento do Praecox", isto que é, proprimente dito, sua "vivência" (tradução que propunha Tosquelles para a palavra Erlebnis), se encontra no que Minkowski (1927) descrevia como "perda do contato vital com a realidade", Binswanger como "falha transcendental" (Binswanger, 2006), e que Blankenburg (1991) chamará mais tarde, retomando as palavras de sua paciente Anne, a "perda da evidência natural". Os esquizofrênicos parecem restritos pela sua doença a viver uma forma específica de épo-ché, uma forma de afastamento da realidade da vida cotidiana que pode se manifestar nos seus retraimentos como na presunção delirante. ...
Este artigo tem como objetivo apresentar a fenomenologia como base epistemológica e ética do movimento desalienista da psicoterapia institucional na França e da Reforma Psiquiátrica no Brasil. Descrevemos estes dois movimentos e os principais nomes que fizeram parte de suas histórias em interlocução com a fenomenologia, refletindo sobre como esta pode ser considerada uma base para a prática de profissionais da saúde mental inseridos neste contexto que está em plena transformação. (Re)discutir tais bases nos parece de fundamental importância para reafirmar o sentido epistemológico e ético necessário que fundamenta ambos os processos. Concluímos que a fenomenologia se apresentou e ainda se apresenta como uma via de questionamento das práticas em saúde mental e oferece o fundamento para se pensar uma prática que busca o encontro com os sujeitos, e não somente com a doença mental, e para o processo de desinstitucionalização dos doentes mentais.
... To point, Minkoswski (Minkoswski, 1927) reported an emotional dysregulation among people with BDspecifically, an excessive emotional "synchronism" with life experiencethat has been recently conceptualised as a hyper-reactivity to emotional stimuli (Corbalán et al., 2015;M'bailara et al., 2009). This emotional hyper-reactivity, referred to and studied in modern times as affective lability, is associated with CT among people with BD (Aas et al., 2017(Aas et al., , 2014a. ...
Background:
Alterations in hippocampal structure and function are present in bipolar disorder (BD). Childhood trauma is associated with risk for BD, and the several subfields of the hippocampus are differentially sensitive to the effects of stressors of the sort associated with risk for BD. The current study therefore sought to test the hypothesis that childhood trauma may be differentially associated with abnormal hippocampal subfield volumes in BD.
Methods:
104 participants with BD type I (BD-I, n = 56) or BD type II (BD-II, n = 48) and 81 healthy controls (HC) underwent high-resolution structural magnetic resonance neuroimaging. Hippocampal subfield volumes were determined using FreeSurfer. Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ).
Results:
There were significant effects of diagnosis on intracranial volume corrected hippocampal subfield volumes bilaterally as well as a significant interaction between diagnosis and childhood trauma. Hippocampal volumes did not differ between the BD-I and BD-II subgroups but hippocampal volumes were smaller in both groups when compared to HC. There was a significant effect of childhood trauma on bilateral presubiculum volume as well as significant interactions between diagnosis and childhood trauma on bilateral CA1, presubiculum and subiculum volumes, the direction of which differed between individuals with BD (larger) and HC (smaller).
Limitations:
Recall bias may influence the reliability of the retrospective assessment of childhood trauma experiences.
Conclusions:
Childhood trauma demonstrates differential effects on hippocampal subfield volumes of BD and HC, particularly in hippocampal subfields involved in emotion regulation.
... Having motivated, outlined, and illustrated a phenomenological-dimensional approach to psychiatric research and classification, my aim in this section is to clarify the relationship 15 between my proposal and a more traditional orientation of phenomenological research. The phenomenological psychopathologist, Minkowski, developed a phenomenological approach that uncovers the trouble générateur, or "generating disorder" (Minkowski, 1927). This genetic 4 orientation investigates 1) the general theme or organization of the psychopathological condition, and 2) the fundamental disturbance at the heart of the disorder, or the alteration that brings about or otherwise influences other aspects of the condition (Sass, 2014, p. 367). ...
The classification of mental illness— enshrined in the Diagnostic and Statistical Manual of Mental Disorders—has historically followed a categorial model of disorder. However, in light of psychiatry’s failure to validate these diagnostic categories, psychiatrists have developed dimensional models for understanding and classifying disorders, such as the National Institute of Mental Health’s Research Domain Criteria initiative. Although some philosophers have recently contributed to the literature on dimensional approaches to psychiatric research and classification, no sustained engagement has yet been offered by continental phenomenologists. In this article, I argue that phenomenological research can benefit from a broadly dimensional orientation—albeit one that differs in many respects from the Research Domain Criteria. Developing this argument, I motivate, outline, and illustrate a phenomenological–dimensional approach. In so doing, I show how a dimensional orientation can circumvent problems stemming from the use of current diagnostic categories as a guide to psychiatric research. In addition, I argue that a dimensional orientation need not conflict with more traditional phenomenological approaches, such as the core gestalt model, and can even complement and support such approaches.
... 43. É aquilo que a psicopatologia fenomenológica igualmente chamou de ambiência. Ver, por exemplo,Minkowski (1927) e Tellenbach (1968. ...
... One of the hallmarks of schizophrenia is impaired volition (Minkowski, 1927;Bleuler, 1950). Recently, several research findings have suggested splitting the negative symptoms of schizophrenia between the motivational dimension, including avolition, anhedonia and asociality, and diminished expressivity, which is characterized by restricted affect and alogia (Blanchard and Cohen, 2006;Strauss et al., 2013). ...
A question that remains to be answered is whether schizophrenia can be characterized by a single etiopathophysiology or whether separate sub-syndromes should be differentiated to define specific mechanisms for each sub-type. Individuals affected by the deficit subtype of schizophrenia (DSZ) display avolitional/amotivational features that respond poorly to conventional treatments. Characterizing DSZ from a neuroanatomical point of view may help clarify this issue and develop new treatment strategies. To determine if DSZ is associated with structural alterations in specific deep grey matter structures linked to its key clinical features, 22 DSZ patients, 22 non-deficit schizophrenia (NDSZ) patients and 22 healthy controls (HC) were recruited for a case-control cross-sectional study. High-resolution magnetic resonance imaging was performed in all subjects and volumes of grey matter structures were measured using FreeSurfer. DSZ patients displayed smaller left accumbens volumes compared to both NDSZ patients and HC. Moreover, age and duration of illness were significantly associated with lower volume of the left accumbens in DSZ but not in NDSZ. Findings indicate that DSZ is associated with lower volume of the nucleus accumbens in the dominant hemisphere. This is consistent with the psychopathological features and functional impairments present in DSZ and thus indicates a potential mechanism.
... Embora a discussão específica sobre esses não seja muito comum em psicoterapia, é possível conceber que os sentidos físicos refiram-se tanto à relação com o mundo e sua materialidade (Bachelard, 2007) como às relações com o outro (Binswanger, 2008) e à constituição histórica da experiência do sujeito , o que abre um espaço de grande pertinência para o processo terapêutico. A reconstituição dessa experiência passa, portanto, necessariamente por modificações na vivência dos sentidos físicos, como uma maior leveza e estabilidade na experiência do mundo (Ellenberger, 2004), no estabelecimento de uma distância vivida mais aceitável para o sujeito (Merleau-Ponty, 2008), na possibilidade do sujeito deixar de se amargar com as imposições do mundo (Binswanger, 2004), no restabelecimento temporal do sujeito diante de seu vir a ser (Minkowski, 2006) e na busca de novos sentidos para a existência (Frankl, 1967). A psicoterapia, inspirada em tais perspectivas, baseia-se num processo empático e dialógico que privilegia a autonomia do sujeito e as produções que lhe são próprias, sem que haja imposições e diretivas da parte do terapeuta . ...
Hypnosis can be an important tool for reconstructing the subjective experiences of subjects. To understand this, we begin with a debate between authors of phenomenology and existentialism who believe that hypnosis, with its directives and the authority claimed by its therapists, is not a legitimate method for reconstructing experiences because the client does not participate as a subject in the process of therapy. Next, a clinical case study is presented that strongly emphasizes the use of the physical senses during hypnosis sessions and illustrates how a client in deep mourning was able to accomplish several reconstructions of her experience related to her body, space, time, and the world. The conclusion is that physical senses, as experienced processes, can be highly significant in psychotherapy, and that hypnosis allows subjects to actively participate in reconstructing their experiences
... Furthermore, it could be connected to real dysfunctional attitudes of parents or to inadequate emotional responses of patients. Already in the early 19th Century, Minkowski highlighted that in manic-depressive illness "synchronism" with life experiences was excessive and inappropriate (Minkoswski, 1927). Today, the existence of hypersensitivity to emotional stimuli in patients with BD is known (M'bailara et al., 2009;Mathieu et al., 2014), even in states of euthymia . ...
... L'hypernomie et l'hétéronomie ont raison de toute tentative d'autonomie dans l'existence de Jonas. Comme le suggère Fuchs [17], ce phénomène d'adhérence à la norme évoque également la notion de syntonie, caractérisant la tendance morbide vers une harmonie parfaite avec l'environnement, que Minkowski reprend à Kretschmer [18,19]. Le nomos sur lequel l'existence s'« aplatit » est déterminé par autrui à travers un rythme temporel effréné. ...
L’objectif de cet article est de réaliser l’étude d’un cas clinique représentatif de la configuration psychopathologique typus melancholicus/mélancolie. Cette analyse nous permet de réaliser une synthèse théorique des travaux entrepris en la matière. À la suite du récent décès de sa mère, notre patient, âgé de 64 ans, exprime un « sentiment de l’absence de sentiment » caractéristique de l’existence émotionnelle mélancolique. Une analyse approfondie de sa biographie permet d’objectiver une configuration anthropologique prémorbide particulière, le typus melancholicus. Ce mode d’être-au-monde précédant l’état mélancolique, décrit par Tellenbach puis par Kraus, se caractérise par le « besoin d’ordre », le « caractère consciencieux », une revendication d’« hyper/hétéronomie » et une « intolérance à l’ambiguïté ». Ces quatre caractéristiques conduisent à un déséquilibre dans la dialectique entre l’identité de rôle et l’identité égoïque. La première partie de l’identité absorbe l’ensemble de la subjectivité d’un sujet qui répond à un rôle, souvent « rentable », socialement valorisé et teinté d’une adaptation superficielle. D’une synchronisation sans faille à sa mère, notre patient se retrouve sans point de repère ; déchu de son rôle, il expérimente un état de profonde désynchronisation.
... Indeed, contemporary psychopathological research emphasizes the relevance of disruption of implicit bodily functioning (of which facial mimicry is a crucial component) for the loss of practical immersion in the intersubjective world that constitutes the hallmark of schizophrenia spectrum vulnerability (see Parnas et al., 2002; Stanghellini, 2004; Fuchs, 2005; Parnas, 2011; see also Ebisch et al., 2012; Ferri et al., 2012; Gallese and Ferri, 2013). Therefore, the disturbance of motor resonance revealed in this study, might be implicated in some of the disorders of intersubjective attunement that phenomenologically-oriented psychopathology indicates as core features of Schizophrenia (Minkowski, 1927; Blankenburg, 1971; Parnas and Bovet, 1991; Parnas et al., 2002). The interpretation of these results grounded on the hypothesis of an impaired functionality of motor resonance mechanisms in patients diagnosed with schizophrenia, should be limited by the lack in our study of direct measures of the entailed underpinning neural mechanisms. ...
Emotional facial expression is an important low-level mechanism contributing to the experience of empathy, thereby lying at the core of social interaction. Schizophrenia is associated with pervasive social cognitive impairments, including emotional processing of facial expressions. In this study we test a novel paradigm in order to investigate the evaluation of the emotional content of perceived emotions presented through dynamic expressive stimuli, facial mimicry evoked by the same stimuli, and their functional relation. Fifteen healthy controls and 15 patients diagnosed with schizophrenia were presented with stimuli portraying positive (laugh), negative (cry) and neutral (control) emotional stimuli in visual, auditory modalities in isolation, and congruently or incongruently associated. Participants where requested to recognize and quantitatively rate the emotional value of the perceived stimuli, while electromyographic activity of Corrugator and Zygomaticus muscles was recorded. All participants correctly judged the perceived emotional stimuli and prioritized the visual over the auditory modality in identifying the emotion when they were incongruently associated (Audio-Visual Incongruent condition). The neutral emotional stimuli did not evoke any muscle responses and were judged by all participants as emotionally neutral. Control group responded with rapid and congruent mimicry to emotional stimuli, and in Incongruent condition muscle responses were driven by what participants saw rather than by what they heard. Patient group showed a similar pattern only with respect to negative stimuli, whereas showed a lack of or a non-specific Zygomaticus response when positive stimuli were presented. Finally, we found that only patients with reduced facial mimicry (Internalizers) judged both positive and negative emotions as significantly more neutral than controls. The relevance of these findings for studying emotional deficits in schizophrenia is discussed.
... For a schizophrenic, it is often difficult to have a spontaneous communication, as Minkowski and Bin Kimura have shown (Minkowski 1927, B. Kimura 1988. He (she) often suffers from this failure (in contrast, an autistic in lower function does not know its existence). ...
This paper seeks to demonstrate the structural difference in communication of schizophrenia and autism. For a normal adult,
spontaneous communication is nothing but the transmission of phantasía (thought) by means of perceptual objects or language.
This transmission is first observed in a make-believe play of child. Husserl named this function “perceptual phantasía,” and
this function presupposes as its basis the “internalized affection of contact” (which functions empirically in eye contact,
body contact, or voice calling me). Regarding autism, because of the innate lack of affection of contact, intersubjective
perceptual phantasía does not occur spontaneously. Consequently, autistics do not engage in make-believe play but in stereotyped
and solipsistic play. Without the formation of perceptual phantasía, there is no differentiation between phantasía and perception.
For this reason, people with Asperger's syndrome consider conversation not an immediate communication of thought but a logical
transmission of concepts. Schizophrenia is characterized by a distortion in the internalized affection of contact, resulting
in a disturbance of perceptual phantasía, and this later is covered by various symptoms—for example, delusion as a pathological
kind of communication of thought. This delusion is based on the pathological internalized affection of contact represented
by a terrifying Other.
KeywordsAutism–Schizophrenia–Communication–Perceptual phantasía–
Phantasieleib
–Affection of contact–Transcendental telepathy–Intersubjectivity
... However, the exact nature of impaired social abilities in schizophrenia remains a topic of speculation and their underlying causes unknown. In particular, although a crucial role has been attributed to the self-and its pre-reflective relationship with the external world in schizophrenic pathology since the early 19th century (Bleuler, 1911; Minkowski, 1927), it still remains an open issue whether functional abnormalities underlying the inability to interrelate with others in Received 22 September 2011; Accepted 19 January 2012 This work was supported by the EU grant TESIS (Towards an Embodied Science of InterSubjectivity) and the EU project ROSSI (Emergence of communication in RObots through Sensorimotor and Social Interaction; Grant agreement no. 216125) to V.G. ...
Social dysfunction has been recognized as an elementary feature of schizophrenia, but it remains a crucial issue whether social deficits in schizophrenia concern the inter-subjective domain or primarily have their roots in disturbances of self-experience. Social perception comprises vicarious processes grounding an experiential inter-relationship with others as well as self-regulation processes allowing to maintain a coherent sense of self. The present study investigated whether the functional neural basis underlying these processes is altered in first-episode schizophrenia (FES). Twenty-four FES patients and 22 healthy control participants underwent functional magnetic resonance imaging during a social perception task requiring them to watch videos depicting other individuals' inanimate and animate/social tactile stimulations, and a tactile localizer condition. Activation in ventral premotor cortex for observed bodily tactile stimulations was reduced in the FES group and negatively correlated with self-experience disturbances. Moreover, FES patients showed aberrant differential activation in posterior insula for first-person tactile experiences and observed affective tactile stimulations. These findings suggest that social perception in FES at a pre-reflective level is characterized by disturbances of self-experience, including impaired multisensory representations and self-other distinction. However, the results also show that social perception in FES involves more complex alterations of neural activation at multiple processing levels.
... Although almost all the funding pioneers of the modern scientific approach to mental disorders have in some way or another commented on the similarities between dreaming and insanity (Bleuler, 1966;Freud, 1958;Jung, 1936;Kraepelin, 1906;Minkowski, 1997), only few contemporary researchers have attempted to bind these complex phenomena (Gottesmann, 2006;Hobson, 2004). Indeed, most of the evidence supporting this observation belongs to a phenomenological perspective, which intrinsically lies on debatable premises due to its reliance on the verbalization of subjective experiences (Mishara, 2007;Parnas, Sass, & Zahavi, 2008). ...
Several independent lines of research in neurobiology seem to support the phenomenologically-grounded view of the dreaming brain/mind as a useful model for psychosis. Hallucinatory phenomena and thought disorders found in psychosis share several peculiarities with dreaming, where internally generated, vivid sensorimotor imagery along with often heightened and incongruous emotion are paired with a decrease in ego functions which ultimately leads to a severe impairment in reality testing. Contemporary conceptualizations of severe mental disorders view psychosis as one psychopathological dimension that may be found across several diagnostic categories. Some experimental data have shown cognitive bizarreness to be equally elevated in dreams and in the waking cognition of acutely psychotic subjects and in patients treated with pro-dopaminergic drugs, independent of the underlying disorder. Further studies into the neurofunctional underpinnings of both conditions will help to clarify the use and validity of this model.
The aim of this chapter is to review the work of psychopathologists who, over the years, have focused their research on the role of the intersubjective atmosphere of the clinician–patient interaction in the diagnostic process. Many authors, in fact, have claimed in the past that phenomena like intuition, empathy, and atmospheric perception can aid in obtaining essential clinical data, enabling the clinician to immediately grasp the characteristics of the patient’s core condition. Most of these authors were inspired by concurrent advancements in the field of phenomenological philosophy, which offered a new perspective on the structures of human subjectivity and intersubjectivity.
In this chapter, the contributions of the scholars who, in the last century, explicitly spoke of “diagnosis through feeling” or similar concepts are discussed and correlated with their philosophical references. The similarities and differences between their proposals are highlighted, especially with regards to the peculiar course of the epistemological perspective, which went through a significant transformation around the middle of the last century.
Introduction:
The clinical encounter is still at the core of the psychiatric evaluation. Since the diagnostic process remains basically clinical in nature, several authors have addressed the complexity of the clinical reasoning process and highlighted the role played by intersubjective phenomena and clinician's feelings. Some recent studies have supported the view of a significant link between the clinician's subjective experience during the assessment and the diagnosis made. In a globalized world, this issue requires a careful reflection, since cultural differences may affect the intersubjective atmosphere of the encounter, which may indirectly influence the clinician's thinking.
Methods:
We used a previously validated instrument, named Assessment of Clinician's Subjective Experience (ACSE), to compare the clinician's subjective experience during the evaluation of Italian patients with the subjective experience of the same clinician during the assessment of foreign patients. The 2 patient groups (n = 42 each) were individually matched for known potential confounders (age, sex, categorical diagnosis, and clinical severity).
Results:
We found no significant differences in mean scores on all ACSE dimensions (tension, difficulty in attune-ment, engagement, disconfirmation, and impotence), which suggests that cultural diversity did not substantially affect the clinician's subjective experience. However, the lack of information about the native country and linguistic proficiency of about a quarter of foreign patients may have limited the possibility to detect subtle or specific differences, especially with regard to the clinician's empathic attunement.
Conclusions:
Although further investigation is needed, our preliminary findings may have significant implications for the reflection upon the clinician's empathic experience as well as pragmatic consequences for the act of psychiatric diagnosis in the cross-cultural encounter.
We open with the question of subjectivity as it is presented in Hamlet; the focus then moves to the breakdown of subjectivity as experienced in extreme situations and clinical psychosis. Gabel’s idea of continuity from psychosis to ideology (false consciousness) is used to show that William S. Burroughs is in fact a theorist of global ideological pathology. The concept of reification allows us to combine the voices of Gabel and Burroughs. This is not a study of what has been said about Burroughs or Shakespeare, our concern is with the future of the City, not the nature of the finger that points towards it. The cycle of “William & William” refers to the birth and destruction of subjectivity as defined by “conditions such as these”.
Samuel Thoma will dem vielfach beklagten Theoriemangel der Sozial-
psychiatrie entgegenwirken Hierfür entwirft er einen phänomenologisch-
anthropologischen Grundriss und beleuchtet das Zusammenspiel von
Common Sense, Verrücktheit und sozialem Raum.
Die Phänomenologie stellt die subjektive Welterfahrung ins Zentrum der Analyse.
Die phänomenologische Psychiatrie untersucht die »Verrückung« dieser Welt. Der
Sozialpsychiatrie wiederum geht es um ein subjektorientiertes, soziales Verständnis
dieser »Verrückung« sowie um ihre sozial orientierte Therapie. Samuel Thoma
verknüpft diese Denktraditionen und schafft damit einen theoretischen Raum,
Sozialpsychiatrie neu zu denken. Mehr noch: er wendet die philosophischen
Erkenntnisse an auf praktische Behandlungsansätze wie Hometreatment oder
Psychoseseminare. Der anthropologische Blick auf Verrücktheitserfahrungen, auf
Sinn und Regeln in sozial geteilten Räumen begründet die praktische Gestaltung der
Hilfen für psychisch erkrankte Menschen.
The psychopathology of Psychopaths present a holistic conception of psychopathy inspired by phenomenological psychopathology and compares it with the mainstream nosographic diagnosis (Schneider, Cleckley, Hare and Cooke). The chapter illustrates how a structural-phenomenological approach enhances the investigation of psychopathy. An epistemological discussion of the concept of emotions reveals that psychopaths are competent at managing emotional stimuli, which bestows a psychological advantage upon them. More specifically, a reflection enlightened by the contributions of phenomenological philosophy on empathy and sympathy clarifies the presentation of “psychopathic being-in-the-world”. Starting with the tension between clinical practice and criticism of the dominant diagnostic scales, we consider the “essential characteristics” of the psychopathic disorder to be: reification of the alter ego without an ego-related disorder, emotional coldness as it provides adaptive benefits, and empathic skills without sympathy.
There are numerous mental diseases that yet require deep investigation in terms of the alteration of the mental state of the patient due to the disease onset. Of course there are other aspects of mental diseases which obviously urgently need exploration, such as cause, cure, etc. However it is only appropriate to consider the alteration of the patient’s mental state in this book. And of all the mental diseases it is schizophrenia which is most relevant in looking for the mental disease with greatest effect on the subject’s mental state. Numerous researchers have pointed out over the last decades that there is a loss of the sense of the inner self in schizophrenia. In particular the illuminating paper of Sass and Parnas (Schizophr Bull 29(3):427–444, 2003) gives an underpinning explanation of the disease along these lines in each of its three manifestations, with positive, negative or disordered symptoms (see also Cermolacce M, Naudin J, Parnas J, Conscious Cogn 16:703–714, 2007; Parnas J, Handest P, Saebye D, Jansson L, Acta Psychiatrica Scandinavica 108:126–133, 2003; Parnas J, Handest P, Jannsson L, Saebye D, Psychopathology 38(5):259–267, 2005; Sass L, Parnas J, Explaining schizophrenia: the relevance of phenomenology. In: Chung MC, Fulford KMW, Graham G (eds) Reconceiving Schizophrenia. Oxford University Press, Oxford, pp 63–95, 2007; Sass L, Madness and modernism. Harvard University Press, Cambridge, MA, 1992). The crucial component of the analysis of these researchers is that of various disturbances in ipseity (the ongoing sense of ‘being there’ accompanying all conscious experience) that can occur for a sufferer, giving a framework with which to understand the disease. Such analyses of schizophrenia in terms of distortions of the self go back much earlier (Berze J, Die Primare Insuffizienz der Psychishcen Aktivitat: Ihr Wesen, ihre Erscheinungen and ihre Bedeutung als Grundstorungen der Dementia Praecox und des hypophrenen Uberhaupt. F Deutke, Leipzig, 1914; Minkowski E, La schizophrenia. Psychopathologie des shizoides et des schizophrenes. Payot, Paris, 1927; Blankenburg W. First steps toward a psychopathology of “common sense (trans: Mishara A). Philos Psychiatry Psychol 8:303–315, 2001; Kimura B, Ecrits de Psychopathologie Phenomenologique. Trans Boderlique. P.U.F, Paris France, 1992; Sass LA, Philos Psychiatry Psychol 8:251–270, 2001). However the more recent work has become more precise and embracing in terms of seeing most forms of schizophrenia as arising from such distortions. It also provides new ways of looking at and diagnosing the disease.
This article describes how today in the United States neurologists diagnose forms of dementia, such as Alzheimer's disease and frontotemporal dementia. Taking as a starting‐point the pervasive context of uncertainty in the diagnosis of neurodegenerative diseases, it examines how uncertainty is not merely an epistemological obstacle to the making of knowledge. On the contrary, the article analyses how uncertainty positively incites the use of clinicians’ ‘feelings’ in diagnostic work. Drawing on observations of clinical consultations and team meetings, it studies how, alongside contemporary instruments of objectification, clinicians use, share, and discuss their ‘feelings’ to ultimately renew knowledge about brain diseases. In documenting the manner in which medical expertise is bound to a concrete experience of the world, this article further explores how experts’ ‘intuition’ can be grasped as a conscious and effortful process, rather than as something ineffable, resisting analysis, and confined to an unconscious background.
Over the past 20 years, the advent of advanced techniques has significantly enhanced our knowledge on the brain. Yet, our understanding of the physiological and pathological functioning of the mind is still far from being exhaustive. Both the localizationist and the reductionist neuroscientific approaches to psychiatric disorders have proven to be largely unsatisfactory and are outdated. Accruing evidence suggests that psychoanalysis can engage the neurosciences in a productive and mutually enriching dialogue that may further our understanding of psychiatric disorders. In particular, advances in brain connectivity research have provided evidence supporting the convergence of neuroscientific findings and psychoanalysis and helped characterize the circuitry and mechanisms that underlie higher brain functions. In the present paper we discuss how knowledge on brain connectivity can impact neuropsychoanalysis, with a particular focus on schizophrenia. Brain connectivity studies in schizophrenic patients indicate complex alterations in brain functioning and circuitry, with particular emphasis on the role of cortical midline structures (CMS) and the default mode network (DMN). These networks seem to represent neural correlates of psychodynamic concepts central to the understanding of schizophrenia and of core psychopathological alterations of this disorder (i.e., ego disturbances and impaired primary process thinking).
Sommario: L'eziologia dell'Epilessia Psicogena è sconosciuta. Ciò nonostante, il numero di evidenze sull'origine, il decorso e la cura di questa condizione è in continuo aumento. L'ipnosi è storicamente nota come terapia efficace ma risultati certi in letteratura sono ancora mancanti. Partendo dal Trattamento Ipnotico Ultrabreve per i Disturbi di Conversione di Camillo Loriedo, l'autore ha sviluppato un intervento focalizzato sugli aspetti peculiari dell'Epilessia Psicogena. Nella prima parte del lavoro, saranno revisionate le principali evidenze neurofunzionali e psicologiche disponibili e sarà illustrata un'ipotesi interpretativa. Nella seconda parte, il Modello della Disconnessione Funzionale farà da guida alla manualizzazione, accompagnata da esempi clinici e suggerimenti tecnici.
Abstract: Etiology of PNES is still unknown. Nonetheless, evidences on its origin, course and therapy are growing. Historically, hypnosis is known to be effective as a therapy but results are still lacking in literature. Drawing upon the Ultra-short Hypnosis-based Treatment for Conversion Disorders developed by Camillo Loriedo, the author elaborate an intervention focused on PNES peculiar features. In the first part of the paper, the most relevant neurofunctional and psychological evidences are reviewed and an interpretative hypothesis is illustrated. In the second part, the Functional Disconnection Model guides a manualization of the hypnotic intervention, with clinical reports and technical suggestions.
During the last 20 years, early phases of psychotic disorders have become one of the major clinical and research issues in psychiatry. It is well known since the last century that schizophrenia and psychotic disorders are characterised by a subclinical prodromal phase that can last weeks, months, or even years before the onset of overt psychotic symptoms. The prodromal phase is important in defining potential risk-markers of progression to psychotic illness and as a target for new biological and psychological treatments to prevent a transition to psychosis. Furthermore, the focus on early phases of psychotic disorders may improve the long term outcomes of patients by reducing the duration of untreated illness 1-3. For all these reasons, during the last two decades a clinical "At Risk Mental State" syndrome and its operational criteria have been described leading to the development of two main early detection approaches: the ultra high risk approach (UHR) and the basic symptoms (BS) approach, each with its assessing instruments. Beside these, another important research front is that of anomalous self-experiences (ASE). ASE have been already widely detailed in early phenomenological descriptions of the core features of schizophrenia that might surface in the prodromal phases. The integration of these approaches could be of great value to enrich current operational criteria with a deeper, experience-close understanding of the unique, subjective perspective of individuals at risk of developing a psychosis. However, the integration of these approaches is not a mere juxtaposition of terms. Indeed, the field of early detection is vexed by an increasing terminological confusion related to the lack of an international consensus catalogue of terms that facilitate the bibliometric proliferation of new expressions that do not allow facile comparison of results from all the early psychosis research groups worldwide 4. Likewise, to date, a diagnostic category for prodromal phases has not yet been included in DSM or ICD despite the presence of the "attenuated psychotic syndrome" in the appendix of the new DSM-5 as a condition for further study 5. From a conceptual point of view, the integration of UHR, BS and ASE approaches awaken the discussion about the existence or not of a psychotic continuum with schizophrenic and affective psychoses at the extremes. Indeed, if the former has been used for the evaluation and monitoring of individuals at high risk of developing a psychotic disorder, the latter describes and assesses a set of symptoms characteristic of schizophrenia spectrum disorders. In closing, we describe the clinical staging model as well as the clinical and research benefits and disadvantages that it could bring for early psychosis.
Patients with schizophrenia suffer from severe autobiographical memory deficits. These have a significant impact on patients’ personal identity and functional status in daily life. Through three studies, we showed that all the subjective characteristics of autobiographical recall are impaired in patients with schizophrenia (distorted perception of subjective time, memory recall less associated with Field visual perspective). The impairment of these subjective aspects of autobiographical recall was linked to the lack of specificity of memories and low level of details in patients’ memories. It is these details which allow vivid memory recall. Hence, we tested the effectiveness of a method which showed that deficits in the strategic retrieval of memory details could be remediated. Patients are able to improve the recall of their memory details when given the necessary means to do so. A cognitive remediation therapy, based on this method, could be set up with patients with schizophrenia.
A growing body of evidence points to the clinical and heuristic value of anomalous subjective experiences (ASEs) for the characterization of schizophrenia spectrum vulnerability and early detection purposes. In particular, a subgroup of ASEs, entailing basic disorders of self-awareness (self-disorders [SDs]), has been shown to constitute a core feature of both clinically overt and latent (schizotaxic) spectrum phenotypes. However, a major limitation for the translational implementation of this research evidence has been a lack of assessment tools capable of encompassing the clinical richness of SDs. Here, we present the initial normative data and psychometric properties of a newly developed instrument (Examination of Anomalous Self-experience [EASE]), specifically designed to support the psychopathological exploration of SDs in both research and "real world" clinical settings. Our results support the clinical validity of the EASE as a tool for assessing anomalies of self-awareness (SDs) and lend credit to the translational potential of a phenomenological exploration of the subjective experience of vulnerability to schizophrenia.
This is an explorative study on the values of persons with schizophrenia based on transcripts of individual therapy sessions
conducted for 40 persons with chart diagnoses of schizophrenia or schizotypal disorder. Values are action-guiding attitudes
that subject human activities to be worthy of praise or blame. The schizophrenic value system conveys an overall crisis of
common sense. The outcome of this has been designated as antagonomia and idionomia. Antagonomia reflects the choice to take an eccentric stand in the face of commonly shared assumptions and the here and now
“other.” Idionomia reflects the feeling of the radical uniqueness and exceptionality of one's being with respect to common
sense and the other human beings. This sentiment of radical exceptionality is felt as a “gift,” often in view of an eschatological
mission or a vocation to a superior, novel, metaphysical understanding of the world. The aim of this study is neither establishing
new diagnostic criteria nor suggesting that values play an etio-pathogenetical role in the development of schizophrenia but
improving our understanding of the “meaning” of schizophrenic experiences and beliefs, and by doing so reducing stigmatization,
and enhancing the specificity and validity of “psychotic symptoms” (especially bizarre delusions) and of “social and occupational
dysfunction” through a detailed description of the anthropological and existential matrix they arise from.
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