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Le cœur en psychanalyse : À propos de… « Ludwig Binswanger » de Caroline Gros
Abstract
Reçu le 17 novembre 2009 Gardez-vous de comprendre ! Lacan [1] pensait à Jaspers [2]. Il n'avait pas lu Binswan-ger. Dommage, c ¸a lui aurait plu. On comprend, en lisant l'excellente (et pour l'heure unique) monographie que Caroline Gros consacre à ce psychiatre philosophe, combien la question de la compréhension, au centre de son oeuvre, trouve quelque échoparadoxal dans l'injonction de Lacan. Pour l'un comme pour l'autre, il s'agit de questionner les fondements de la compréhension. Que veut dire comprendre ? Que comprenons-nous au juste lorsque nous disons à propos d'autrui : je le comprends ? Voulons-nous dire : je me mets à sa place, ce qui reste de l'ordre de la psychologie populaire et rapporte l'autre à une pâle copie de soi ? Ou plus profondément, voulons-nous dire : qu'est-ce que l'autre vit vraiment en première personne et qui fait qu'aucun autre Soi ne peut lui être substitué ? C'est cette seconde voie qu'approfondît Binswanger sa vie durant. Comme Lacan, et bien avant lui, sur la base de l'énigme de la rencontre de l'autre, Binswanger va proposer une épistémologie critique de la psychanalyse. Critique de la notion de transfert qui tend à rapporter excessivement la relation présente à la seule répétition du passé, dès lors que cette répétition est pensée comme une explication finale. Critique de la notion de pulsion, qui en cherchant l'explication ultime dans la sexualité infantile alourdit l'interprétation d'une fonction biologique encore trop enracinée dans l'organe. Critique enfin de la notion de psyche, dont on ne peut faire une science sans questionner au préalable les fondements mêmes de la science dans Gros M. Ludwig Binswanger. Chatou : éditions de la Transparence 2009.
... » Ainsi l'espace qui s'ouvre dans la rencontre explicitante semble être de l'ordre de cet espace infini découvert entre un « je » et un « tu », un soi et un autre, autrement dit l'espace de la nostrité décrit par Binswanger (cité par Naudin [20], et voir aussi [1] p 69), un espace sans frontière, ni spatiale ni temporelle, donc non mesurable objectivement. Tout se passe comme si : « « Je » et « tu » se spatialisent l'un l'autre mutuellement … ce qui , chez Heidegger, ne fait qu'un , à savoir la question de l'être, fait deux chez Binswanger, car l'être d'autrui est requis pour donner accès à l'ouverture absolument primordiale de l'être » [8] cité dans [20]. Cependant, nous pourrions également entendre le souci heideggérien non plus seulement comme angoisse lugubre face la mort en tant qu' ultime possibilité, mais plutôt comme être--à--l'autre fondamental, se teintant alors sans le dire de cette dimension d'amour originaire... Comme le montre Naudin dans [20]: « Binswanger, avec Freud, nous montre que [l'] interprétation [en thérapie] reprend toujours à son propre compte et sous diverses formes le fil conducteur d'une histoire d'amour. ...
... Nous serons alors amenés à centrer notre intérêt sur l'intersubjectivité en tant qu'être--avec, co--existence au sens de Heidegger. Nous nous rapprocherons ainsi de l'analyse existentielle de Binswanger [5,6] pour qui l'amour tout autant que l'angoisse, révèle au Dasein son être le plus propre [20]. L'entretien d'explicitation et l'objectivation de la subjectivité. ...
This article examines the structure of self-consciousness in people with schizophrenia. The findings indicate that our self-experience is not neutral with respect to the metaphysical status of the self and that it is important to attend carefully to the experience of the subject in order to understand schizophrenia. The results also suggest that the variable disruptions in the sense of self-presence, first-person perspective, and the phenomenality of experience in schizophrenics directly affect the minimal self and it may also have implications for the narrative self.
In recent years, there has been much focus on the apparent heterogeneity of schizophrenic symptoms. By contrast, this article
proposes a unifying account emphasizing basic abnormalities of consciousness that underlie and also antecede a disparate assortment
of signs and symptoms. Schizophrenia, we argue, is fundamentally a self-disorder or ipseity disturbance (ipse is Latin for “self” or “itself”) that is characterized by complementary distortions of the act of awareness: hyperreflexivity
and diminished self-affection. Hyperreflexivity refers to forms of exaggerated self-consciousness in which aspects of oneself
are experienced as akin to external objects. Diminished self-affection or self-presence refers to a weakened sense of existing
as a vital and self-coinciding source of awareness and action. This article integrates recent psychiatric research and European
phenomenological psychiatry with some current work in cognitive science and phenomenological philosophy. After introducing
the phenomenological approach along with a theoretical account of normal consciousness and self-awareness, we turn to a variety
of schizophrenic syndromes. We examine positive, then negative, and finally disorganization symptoms—attempting in each case
to illuminate shared distortions of consciousness and the sense of self. We conclude by discussing the possible relevance
of this approach for identifying early schizophrenic symptoms.
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.
The subjective experience of time is a fundamental constituent of human consciousness and can be disturbed under conditions
of mental disorders such as schizophrenia or affective disorders. Besides the scientific domain of psychiatry, time consciousness
is a topic that has been extensively studied both by theoretical philosophy and cognitive neuroscience. It can be shown that
both approaches exemplified by the philosophical analysis of time consciousness (Husserl) and the neuroscientific theory of
cross-temporal contingencies (binding of cognitive processes over time) as the neurophysiological basis of human consciousness
implemented in the prefrontal cortex (Fuster) converge in 2 respects. Firstly, a tripartite conception of consciousness divides
human cognition in 3 different temporal domains comprising retention, presentation, and protention (Husserl) and the past, the present, and the future corresponding to working memory, interference control, and preparatory set (Fuster). Secondly, both concepts refer to the present as an extended duration that integrates information from the recent
past and the future. We propose that the integration of phenomenological and neuroscientific approaches can stimulate the
development of enriched pathophysiological concepts of mental disorders. This approach appears to be particularly fruitful
with respect to schizophrenia that is interpreted as a structural disturbance of time consciousness.
From phenomenological and experimental perspectives, research in schizophrenia has emphasized deficits in "higher" cognitive functions, including attention, executive function, as well as memory. In contrast, general consensus has viewed dysfunctions in basic perceptual processes to be relatively unimportant in the explanation of more complex aspects of the disorder, including changes in self-experience and the development of symptoms such as delusions. We present evidence from phenomenology and cognitive neuroscience that changes in the perceptual field in schizophrenia may represent a core impairment. After introducing the phenomenological approach to perception (Husserl, the Gestalt School), we discuss the views of Paul Matussek, Klaus Conrad, Ludwig Binswanger, and Wolfgang Blankenburg on perception in schizophrenia. These 4 psychiatrists describe changes in perception and automatic processes that are related to the altered experience of self. The altered self-experience, in turn, may be responsible for the emergence of delusions. The phenomenological data are compatible with current research that conceptualizes dysfunctions in perceptual processing as a deficit in the ability to combine stimulus elements into coherent object representations. Relationships of deficits in perceptual organization to cognitive and social dysfunction as well as the possible neurobiological mechanisms are discussed.
The chapter begins with a detailed case history of a female patient named Ellen West. The case history is followed by an existential analysis, a psychoanalysis, and a psychopathological clinical analysis of Ellen West. The author designates the case of Ellen West as schizophrenia. It may to some colleagues seem striking, even devious, that the author begins an attempt to elucidate from the anthropological side the problem of schizophrenia with a case which shows "no intellectual defect," no secondary schizophrenic symptoms such as delusion and hallucinations, blocking or stereotypy, and which exhibits a multitude of apparently nonschizophrenic features, in addition to showing a predominantly manic-depressive heredity. The author counters these objections with the statement that precisely in this case we were able to trace and display step by step, through the tangle and vagueness of the symptomatology, the progressive narrowing, loss of power, and "mundanizing," (
Verweltlichung) or, psychopathologically expressed, the emptying of the personality as observed in the schizophrenic process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Contemporary researchers have tended to examine dysfunction among the lives of persons with schizophrenia as a matter of the impact of biological and social forces. While this has greatly advanced the knowledge base, any account of schizophrenia without a full consideration of the illness's first-person dimensions risks missing that schizophrenia is a disorder that interrupts the lives of people who must continue to struggle to find and create security and meaning. While literature from a range of sources has explored self-experience in schizophrenia, one barrier to the creation of a larger synthesis and application of this work is that it remains unclear whether, and to what degree, these differing views of self-experience are comparable with one another. To address this issue, this article reviews 6 different accounts of self-experience, a fundamental, first-person dimension of schizophrenia. The 6 are early psychiatry, existential psychiatry, psychoanalysis, phenomenology, psychosocial rehabilitation, and dialogical psychology. After comparing and contrasting the 6, we conclude that there is a wide-ranging, if general consensus, which suggests that many suffering from schizophrenia experience themselves as diminished relative to their former selves, ie, after onset they experience themselves as less able to engage the world effectively, which intensifies their anxieties in the face of everyday interactions. However, within this broad consensus, significant disagreements exist around issues such as whether these difficulties meaningfully predate the illness, how recovery is possible, and if so, under what conditions. In closing, we suggest a program of research to address these disagreements.
Disorders of self-experience were emphasized in classic literature and in phenomenological psychiatry as essential clinical features of the schizophrenia spectrum disorders, but are neglected in the contemporary psychopathology due to epistemologically motivated distrust of studying anomalies of subjectivity. Based on our own and other empirical studies, we present here detailed clinical phenomenological descriptions of nonpsychotic anomalies of self-experience that may be observable in the prodromal phases of schizophrenia and in the schizotypal disorders. Anomalies of self-experience are grouped according the experiential domain that appears to be affected and are illustrated by short vignettes or verbatim quotes from the patients. It is suggested that disorders of the self deserve further systematic empirical investigations, also from an etiological perspective. Self-disorders may turn out to be potentially useful as a psychopathological organizer of the schizophrenia spectrum disorders. Psychopathological emphasis on these disorders may also help to integrate the search for the neurodevelopmental mechanisms in schizophrenia with developmental-psychological research on the ontogenesis of the self.
During the 19th century and early 20th century, American psychiatry shared many intellectual traditions and values with Great Britain and Europe. These include principles derived from the Enlightenment concerning the dignity of the individual and the value of careful observation. During the 20th century, however, American psychiatry began to diverge, initially due to a much stronger emphasis on psychoanalytic principles, particularly in comparison with Great Britain. By the 1960s and 1970s, studies such as the US-UK study and the International Pilot Study of Schizophrenia demonstrated that the psychodynamic emphasis had gone too far, leading to diagnostic imprecision and inadequate evaluation of traditional evaluations of signs and symptoms of psychopathology. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) was developed in this context, under the leadership of representatives from institutions that had retained the more traditional British-European approaches (eg, Washington University, Iowa). The goal of DSM-III was to create a comprehensive system for diagnosing and evaluating psychiatric patients that would be more reliable, more valid, and more consistent with international approaches. This goal was realized in many respects, but unfortunately it also had many unintended consequences. Although the original creators realized that DSM represented a "best effort" rather than a definitive "ground truth," DSM began to be given total authority in training programs and health care delivery systems. Since the publication of DSM-III in 1980, there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual person's problems and social context and that is enriched by a good general knowledge of psychopathology. Students are taught to memorize DSM rather than to learn complexities from the great psychopathologists of the past. By 2005, the decline has become so severe that it could be referred to as "the death of phenomenology in the United States."
Phenomenological analyses suggest that persons with schizophrenia have profound difficulties with meaningfully engaging the world and situating a sense of self intersubjectively, which leads to the experience of self as absent. In this paper we explore the implications of this view for understanding the workings and potential of individual psychotherapy. Following an examination of individual psychotherapy transcripts for over 60 persons with schizophrenia-spectrum disorders we offer four principles for psychotherapy and provide clinical vignettes to exemplify these points. We suggest that the psychotherapy of persons with schizophrenia may be conceptualised as a "dialogical prosthesis" that helps individuals recover past selves then kindle internal and external dialogue, which partially enables a sense of the self to emerge. The therapeutic process consists of assisting persons to move towards recovery by providing an intersubjective space where they can evolve the first-person perspective of themselves and the second-person perspective when encountering others.
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