Background: According to Karl Jaspers, psychopathology
requires a comprehensive method, understo... more Background: According to Karl Jaspers, psychopathology
requires a comprehensive method, understood as a systematic
exploration of the first-person perspective of the patient’s
experience. At the same time, however, schizophrenia
for Jaspers is characterized by its radical incomprehensibility.
In addition, Rümke’s so-called “praecox feeling”
paradoxically combines the incomprehensibility of schizophrenic
experience and the evidence of its pathological
manifestation in the encounter. Aim: Through a re-examination
of the notions of affectivity and interaffective contact
we propose a coherent theoretical model to explain the clinician’s
paradoxical understanding of schizophrenia. Method:
Phenomenological tradition regards affectivity as an encompassing
phenomenon that connects body, self, world,
and others. In our view, only a thorough and systematic link
between corporeity and affectivity is able to explain embodied affective resonance as a basis of empathic comprehension.
By drawing on the phenomenology of Marc Richir,
we will systematically unfold the complex nature of affectivity
and lead it back to a twofold constitution of corporeality.
Conclusion: The Richirian account on affectivity can be
fruitfully put into discussion with other recent phenomenological
models on schizophrenia. It might be able to exhibit
affectivity as the operative ground of minimal self-disturbance
and thus argue for its intersubjective dimension.
Rendre explicites les liens qui unissent psychothérapie institutionnelle et phénoménologie est un... more Rendre explicites les liens qui unissent psychothérapie institutionnelle et phénoménologie est une tâche ardue tant ces deux traditions se sont interpénétrées. C'est au microscope qu'il faudrait progresser dans cette botte de foin, examiner avec rigueur les trajectoires et rencontres de ceux qui en ont fait la fécondité. Clarifions d'abord le champ et mettons-nous d'accord : nous traiterons ici (dans ce modeste aperçu) de la psychothérapie institutionnelle non comme d'une technique déjà sédimentée dans l'histoire mais plutôt comme d'un mouvement, un projet tant clinique que politique. À ce propos, François Tosquelles nous mettait en garde : « La psychothérapie institutionnelle en soi, cela n'existe pas. » Il ne s'agit donc pas pour nous de s'appesantir sur un passé réifié en fétiche mais de tisser des liens vivants pour les cliniciens d'aujourd'hui.
Schizophrenia may result from immune or inflammatory disorders, which are mediated by cytokines. ... more Schizophrenia may result from immune or inflammatory disorders, which are mediated by cytokines. Data in this field are heterogeneous and often contradictory. We investigated circulating levels of IL-6 and TNF-alpha, two distinct proinflammatory cytokines. Using immunoassay, we assessed IL-6 and TNF-alpha in serum from chronic schizophrenic patients (n = 30) and normal controls (n = 15). Circulating levels of IL-6 were higher in patients than in controls; those of TNF-alpha were not significantly higher than in controls. In addition, IL-6 levels were higher in patients with acute exacerbation of schizophrenia than in patients with remissions. Our results suggest that immunologic abnormalities in schizophrenia may be related to a specific inflammatory process mediated by IL-6. An interesting line of research would be the evaluation of IL-6 cerebral production in CSF.
Dans une tentative de compréhension épistémologique de la clinique, on voit celle-ci osciller ent... more Dans une tentative de compréhension épistémologique de la clinique, on voit celle-ci osciller entre deux pôles : l'un inférentiel, l'autre perceptif. Dans une approche catégorielle de la maladie, la démarche inférentielle remonte des symptômes visibles à la catégorie pathologique censée en être la cause. Ce faisant, on se soustrait ainsi -en psychiatrie -de la perception instantanée qu'on peut avoir du malade, en même temps que de la maladie comme phénomène changeant, qui évolue. D'un point de vue phénoménologique, le modèle perceptif permet au thérapeute, au sein de la rencontre, de voir émerger en lui l'impression d'une attitude globale du patient. Grâce à l'épochè, un sentiment de forme, de Gestalt va se faire jour en lui. Néanmoins, le cas clinique est toujours un construit, un récit produit intersubjectivement, mais toujours à propos de la maladie et à partir du malade. L'accumulation des cas cliniques aboutit au cas « type », cas singulier, en rapport duquel le cas clinique va dès lors pouvoir se reconnaître sur le mode d'un « air de famille », comme le particulier dans son rapport à l'Eidos platonicienne. Permettre le lien entre la perception et l'inférence, comme entre le vécu subjectif et le récit intersubjectif ou la personne et le type, constitue l'apport de l'approche phénoménologique à l'expérience clinique.
Pro-inflammatory cytokines are dysregulated in schizophrenia. To determine the nature of the so-c... more Pro-inflammatory cytokines are dysregulated in schizophrenia. To determine the nature of the so-called inflammatory syndrome in schizophrenia, we investigated the circulating levels of various cytokines (interleukin (IL)-1 beta, IL-6, tumor necrosis factor (TNF)alpha), their natural antagonist (IL1-ra, TNF-RI, TNF-RII) and leukocyte activation markers (the soluble receptor of interleukin-2, soluble CD14 and soluble CD23) in subjects with chronic schizophrenia (n = 18) and in normal controls (n = 21). The levels of IL-1 beta and its antagonist and the levels of leukocyte activation markers were not significantly differents between patients and controls. Circulating levels of TNF alpha were significantly (p < 0.05) higher in patients than in controls and did not result from variations of its antagonist levels. The significant (p < 0.05) increase in patient IL-6 was related specifically to clinical status, i.e. illness duration. These data suggest a specific cytokine-mediated syndrome in schizophrenia. We hypothesize that TNF alpha and IL-6 reflect the genetic background of disease suceptibility.
There is new interest in subjective experiences of schizophrenia. This kind of analysis emphasize... more There is new interest in subjective experiences of schizophrenia. This kind of analysis emphasizes the subjective stories of patients, and the methods do not pretend to have the objectivity of science. However, the plausibility and the empathetic resonance of the single case may bring subjective confirmation to the validity of an insight and indicate new directions of research. Following this line, the authors present a study of 3 single cases of 'reflexive' residual type of schizophrenia. The methods for selecting the cases and the philosophical groundings of the concept of 'reflexive schizophrenia' are explained. The analysis of the single cases revealed that (1) schizophrenic persons' cognitive deficit is related to the constitution of common sense; (2) some schizophrenics cope with the cognitive deficit by creating a theoretical corpus of axioms stemming from common sense, namely the 'axioms of everyday life'; (3) this mechanism of coping is described as an inflexible attachment to 'axioms of everydayness', and (4) this attachment to common sense releases the patient from all personal investment of self in the process of anchoring in the living world and, on this basis, allows a relatively solid, although distant, attachment to reality. The nature of deficit in schizophrenia is also discussed by confronting the phenomenological point of view and the neuropsychological, that is the so-called 'theory of mind'.
Abstract: The authors compared delusions of male schizophrenics (56 cases) with those of female s... more Abstract: The authors compared delusions of male schizophrenics (56 cases) with those of female schizophrenics (41 cases) on the following points: 1) characteristics of objects of delusions, i) existence of the central object, ii) their description on this central object, iii) ...
Résumé Face aux difficultés intersubjectives des patients schizophrènes, les neurosciences actuel... more Résumé Face aux difficultés intersubjectives des patients schizophrènes, les neurosciences actuelles proposent différents modèles, où deux grands courants théoriques peuvent être distingués. Un premier modèle cognitif donne une place cruciale à la capacité à attribuer des intentions chez autrui, en termes de théorie de l'esprit. Un second modèle développe la notion d'empathie par simulation, à un niveau plus corporel et plus automatique. Différentes critiques peuvent être adressées à ces deux conceptions, notamment dans une perspective phénoménologique. Dans le prolongement de ces critiques, l'étude d'un cas singulier nous montre les limites d'un modèle qui négligerait la dimension corporelle et préréflexive, ou qui http://france.elsevier.com/direct/EVOPSY/ L'Évolution psychiatrique 70 731-744 ☆ Toute référence à cet article doit porter mention : Cermolacce M., Laurence D., Naudin J., Parnas J. Sommes-nous tous des spécialistes des gens ? Intersubjectivité, théorie de l'esprit et schizophrénie. Evol. Psychiatr. 2005 ; 70.
Nous avons recueilli des données lors d'une recherche ethnographique d'un an au sein d'une équipe... more Nous avons recueilli des données lors d'une recherche ethnographique d'un an au sein d'une équipe de travailleurs pairs, dans la ville de New Haven (États-Unis). Nous proposons, à partir de cette expérience, une approche phénoménologique de la relation thérapeutique en étudiant trois types de relations que des http://france.elsevier.com/direct/EVOPSY/ L'Évolution psychiatrique ■■ (2006) ■■■ ☆ Toute référence à cet article doit porter mention : Girard V, Driffin K, Musso S, Naudin J, Rowe M, Davidson L, Lovell AM. La relation thérapeutique sans le savoir. Approche anthropologique de la rencontre entre travailleurs pairs et personnes sans chez-soi ayant une cooccurrence psychiatrique. Evol. Psychiatr. 2006 ; 71. catégories professionnelles distinctes (psychiatre, anthropologue, travailleur pair) entretiennent avec ces personnes à la fois malades et sans chez-soi. Du fait des interactions souvent problématiques des personnes sans chez-soi avec les institutions, dans le travail de rue la difficulté est d'abord de créer une relation de confiance, dont la construction peut être longue et chaotique. Parce qu'ils les ont éprouvés, les pairs connaissent à la fois le contexte de la rue, la condition de sans chez-soi et l'expérience de la maladie. Cette dernière comprend non seulement le fait d'avoir été l'objet d'une catégorisation psychiatrique mais aussi les conséquences de celle-ci, l'interaction avec les institutions en tant qu'usager, et surtout l'expérience d'un processus avancé de recovery. Ils possèdent une compétence singulière qui permet d'améliorer l'accès aux soins de ces personnes. La question de la bonne distance thérapeutique est revisitée par le travail des pairs. Valoriser ce savoir expérientiel par la professionnalisation des pairs est un acte de reconnaissance d'un capital culturel singulier et de démocratie sanitaire.
The aim of the study is to compare the expression level of candidate genes between patients suffe... more The aim of the study is to compare the expression level of candidate genes between patients suffering from a severe major depressive episode (MDE) and controls, and also among patients during MDE evolution. After a comprehensive review of the biological data related to mood disorders, we initiated a hypothesis-driven exploration of candidate mRNAs. Using RT-qPCR, we analyzed peripheral blood mononuclear cells (PBMCs) mRNA obtained from a homogeneous population of 11 patients who suffered from severe melancholic MDE. To assess the evolution of MDE, we analyzed PBMC mRNAs that were collected on Day 1 and 8 weeks later. Data from these patient samples were analyzed in comparison to age-and sex-matched healthy controls. Among 40 candidate genes consistently transcribed in PBMCs, 10 were differentially expressed in at least one comparison. We found that variations of mRNA levels for NRG1, SORT1 and TPH1 were interesting state-dependent biological markers of the disease. We also observed that variations in other mRNA expression were associated with treatment efficacy or clinical improvement (CREB1, HDAC5, HSPA2, HTR1B, HTR2A, and SLC6A4/5HTT). Significantly, 5HTT exhibited a strong correlation with clinical score evolution. We also found a state-independent marker, IL10. Moreover, the analysis of 2 separate MDEs concerning a same patient revealed comparable results for the expression of CREB1, HSPA2, HTR1B, NRG1 and TPH1. Overall, our results indicate that PBMCs obtained at different time points during MDE progression represent a promising avenue to discover biological markers for depression.
Background: According to Karl Jaspers, psychopathology
requires a comprehensive method, understo... more Background: According to Karl Jaspers, psychopathology
requires a comprehensive method, understood as a systematic
exploration of the first-person perspective of the patient’s
experience. At the same time, however, schizophrenia
for Jaspers is characterized by its radical incomprehensibility.
In addition, Rümke’s so-called “praecox feeling”
paradoxically combines the incomprehensibility of schizophrenic
experience and the evidence of its pathological
manifestation in the encounter. Aim: Through a re-examination
of the notions of affectivity and interaffective contact
we propose a coherent theoretical model to explain the clinician’s
paradoxical understanding of schizophrenia. Method:
Phenomenological tradition regards affectivity as an encompassing
phenomenon that connects body, self, world,
and others. In our view, only a thorough and systematic link
between corporeity and affectivity is able to explain embodied affective resonance as a basis of empathic comprehension.
By drawing on the phenomenology of Marc Richir,
we will systematically unfold the complex nature of affectivity
and lead it back to a twofold constitution of corporeality.
Conclusion: The Richirian account on affectivity can be
fruitfully put into discussion with other recent phenomenological
models on schizophrenia. It might be able to exhibit
affectivity as the operative ground of minimal self-disturbance
and thus argue for its intersubjective dimension.
Rendre explicites les liens qui unissent psychothérapie institutionnelle et phénoménologie est un... more Rendre explicites les liens qui unissent psychothérapie institutionnelle et phénoménologie est une tâche ardue tant ces deux traditions se sont interpénétrées. C'est au microscope qu'il faudrait progresser dans cette botte de foin, examiner avec rigueur les trajectoires et rencontres de ceux qui en ont fait la fécondité. Clarifions d'abord le champ et mettons-nous d'accord : nous traiterons ici (dans ce modeste aperçu) de la psychothérapie institutionnelle non comme d'une technique déjà sédimentée dans l'histoire mais plutôt comme d'un mouvement, un projet tant clinique que politique. À ce propos, François Tosquelles nous mettait en garde : « La psychothérapie institutionnelle en soi, cela n'existe pas. » Il ne s'agit donc pas pour nous de s'appesantir sur un passé réifié en fétiche mais de tisser des liens vivants pour les cliniciens d'aujourd'hui.
Schizophrenia may result from immune or inflammatory disorders, which are mediated by cytokines. ... more Schizophrenia may result from immune or inflammatory disorders, which are mediated by cytokines. Data in this field are heterogeneous and often contradictory. We investigated circulating levels of IL-6 and TNF-alpha, two distinct proinflammatory cytokines. Using immunoassay, we assessed IL-6 and TNF-alpha in serum from chronic schizophrenic patients (n = 30) and normal controls (n = 15). Circulating levels of IL-6 were higher in patients than in controls; those of TNF-alpha were not significantly higher than in controls. In addition, IL-6 levels were higher in patients with acute exacerbation of schizophrenia than in patients with remissions. Our results suggest that immunologic abnormalities in schizophrenia may be related to a specific inflammatory process mediated by IL-6. An interesting line of research would be the evaluation of IL-6 cerebral production in CSF.
Dans une tentative de compréhension épistémologique de la clinique, on voit celle-ci osciller ent... more Dans une tentative de compréhension épistémologique de la clinique, on voit celle-ci osciller entre deux pôles : l'un inférentiel, l'autre perceptif. Dans une approche catégorielle de la maladie, la démarche inférentielle remonte des symptômes visibles à la catégorie pathologique censée en être la cause. Ce faisant, on se soustrait ainsi -en psychiatrie -de la perception instantanée qu'on peut avoir du malade, en même temps que de la maladie comme phénomène changeant, qui évolue. D'un point de vue phénoménologique, le modèle perceptif permet au thérapeute, au sein de la rencontre, de voir émerger en lui l'impression d'une attitude globale du patient. Grâce à l'épochè, un sentiment de forme, de Gestalt va se faire jour en lui. Néanmoins, le cas clinique est toujours un construit, un récit produit intersubjectivement, mais toujours à propos de la maladie et à partir du malade. L'accumulation des cas cliniques aboutit au cas « type », cas singulier, en rapport duquel le cas clinique va dès lors pouvoir se reconnaître sur le mode d'un « air de famille », comme le particulier dans son rapport à l'Eidos platonicienne. Permettre le lien entre la perception et l'inférence, comme entre le vécu subjectif et le récit intersubjectif ou la personne et le type, constitue l'apport de l'approche phénoménologique à l'expérience clinique.
Pro-inflammatory cytokines are dysregulated in schizophrenia. To determine the nature of the so-c... more Pro-inflammatory cytokines are dysregulated in schizophrenia. To determine the nature of the so-called inflammatory syndrome in schizophrenia, we investigated the circulating levels of various cytokines (interleukin (IL)-1 beta, IL-6, tumor necrosis factor (TNF)alpha), their natural antagonist (IL1-ra, TNF-RI, TNF-RII) and leukocyte activation markers (the soluble receptor of interleukin-2, soluble CD14 and soluble CD23) in subjects with chronic schizophrenia (n = 18) and in normal controls (n = 21). The levels of IL-1 beta and its antagonist and the levels of leukocyte activation markers were not significantly differents between patients and controls. Circulating levels of TNF alpha were significantly (p < 0.05) higher in patients than in controls and did not result from variations of its antagonist levels. The significant (p < 0.05) increase in patient IL-6 was related specifically to clinical status, i.e. illness duration. These data suggest a specific cytokine-mediated syndrome in schizophrenia. We hypothesize that TNF alpha and IL-6 reflect the genetic background of disease suceptibility.
There is new interest in subjective experiences of schizophrenia. This kind of analysis emphasize... more There is new interest in subjective experiences of schizophrenia. This kind of analysis emphasizes the subjective stories of patients, and the methods do not pretend to have the objectivity of science. However, the plausibility and the empathetic resonance of the single case may bring subjective confirmation to the validity of an insight and indicate new directions of research. Following this line, the authors present a study of 3 single cases of 'reflexive' residual type of schizophrenia. The methods for selecting the cases and the philosophical groundings of the concept of 'reflexive schizophrenia' are explained. The analysis of the single cases revealed that (1) schizophrenic persons' cognitive deficit is related to the constitution of common sense; (2) some schizophrenics cope with the cognitive deficit by creating a theoretical corpus of axioms stemming from common sense, namely the 'axioms of everyday life'; (3) this mechanism of coping is described as an inflexible attachment to 'axioms of everydayness', and (4) this attachment to common sense releases the patient from all personal investment of self in the process of anchoring in the living world and, on this basis, allows a relatively solid, although distant, attachment to reality. The nature of deficit in schizophrenia is also discussed by confronting the phenomenological point of view and the neuropsychological, that is the so-called 'theory of mind'.
Abstract: The authors compared delusions of male schizophrenics (56 cases) with those of female s... more Abstract: The authors compared delusions of male schizophrenics (56 cases) with those of female schizophrenics (41 cases) on the following points: 1) characteristics of objects of delusions, i) existence of the central object, ii) their description on this central object, iii) ...
Résumé Face aux difficultés intersubjectives des patients schizophrènes, les neurosciences actuel... more Résumé Face aux difficultés intersubjectives des patients schizophrènes, les neurosciences actuelles proposent différents modèles, où deux grands courants théoriques peuvent être distingués. Un premier modèle cognitif donne une place cruciale à la capacité à attribuer des intentions chez autrui, en termes de théorie de l'esprit. Un second modèle développe la notion d'empathie par simulation, à un niveau plus corporel et plus automatique. Différentes critiques peuvent être adressées à ces deux conceptions, notamment dans une perspective phénoménologique. Dans le prolongement de ces critiques, l'étude d'un cas singulier nous montre les limites d'un modèle qui négligerait la dimension corporelle et préréflexive, ou qui http://france.elsevier.com/direct/EVOPSY/ L'Évolution psychiatrique 70 731-744 ☆ Toute référence à cet article doit porter mention : Cermolacce M., Laurence D., Naudin J., Parnas J. Sommes-nous tous des spécialistes des gens ? Intersubjectivité, théorie de l'esprit et schizophrénie. Evol. Psychiatr. 2005 ; 70.
Nous avons recueilli des données lors d'une recherche ethnographique d'un an au sein d'une équipe... more Nous avons recueilli des données lors d'une recherche ethnographique d'un an au sein d'une équipe de travailleurs pairs, dans la ville de New Haven (États-Unis). Nous proposons, à partir de cette expérience, une approche phénoménologique de la relation thérapeutique en étudiant trois types de relations que des http://france.elsevier.com/direct/EVOPSY/ L'Évolution psychiatrique ■■ (2006) ■■■ ☆ Toute référence à cet article doit porter mention : Girard V, Driffin K, Musso S, Naudin J, Rowe M, Davidson L, Lovell AM. La relation thérapeutique sans le savoir. Approche anthropologique de la rencontre entre travailleurs pairs et personnes sans chez-soi ayant une cooccurrence psychiatrique. Evol. Psychiatr. 2006 ; 71. catégories professionnelles distinctes (psychiatre, anthropologue, travailleur pair) entretiennent avec ces personnes à la fois malades et sans chez-soi. Du fait des interactions souvent problématiques des personnes sans chez-soi avec les institutions, dans le travail de rue la difficulté est d'abord de créer une relation de confiance, dont la construction peut être longue et chaotique. Parce qu'ils les ont éprouvés, les pairs connaissent à la fois le contexte de la rue, la condition de sans chez-soi et l'expérience de la maladie. Cette dernière comprend non seulement le fait d'avoir été l'objet d'une catégorisation psychiatrique mais aussi les conséquences de celle-ci, l'interaction avec les institutions en tant qu'usager, et surtout l'expérience d'un processus avancé de recovery. Ils possèdent une compétence singulière qui permet d'améliorer l'accès aux soins de ces personnes. La question de la bonne distance thérapeutique est revisitée par le travail des pairs. Valoriser ce savoir expérientiel par la professionnalisation des pairs est un acte de reconnaissance d'un capital culturel singulier et de démocratie sanitaire.
The aim of the study is to compare the expression level of candidate genes between patients suffe... more The aim of the study is to compare the expression level of candidate genes between patients suffering from a severe major depressive episode (MDE) and controls, and also among patients during MDE evolution. After a comprehensive review of the biological data related to mood disorders, we initiated a hypothesis-driven exploration of candidate mRNAs. Using RT-qPCR, we analyzed peripheral blood mononuclear cells (PBMCs) mRNA obtained from a homogeneous population of 11 patients who suffered from severe melancholic MDE. To assess the evolution of MDE, we analyzed PBMC mRNAs that were collected on Day 1 and 8 weeks later. Data from these patient samples were analyzed in comparison to age-and sex-matched healthy controls. Among 40 candidate genes consistently transcribed in PBMCs, 10 were differentially expressed in at least one comparison. We found that variations of mRNA levels for NRG1, SORT1 and TPH1 were interesting state-dependent biological markers of the disease. We also observed that variations in other mRNA expression were associated with treatment efficacy or clinical improvement (CREB1, HDAC5, HSPA2, HTR1B, HTR2A, and SLC6A4/5HTT). Significantly, 5HTT exhibited a strong correlation with clinical score evolution. We also found a state-independent marker, IL10. Moreover, the analysis of 2 separate MDEs concerning a same patient revealed comparable results for the expression of CREB1, HSPA2, HTR1B, NRG1 and TPH1. Overall, our results indicate that PBMCs obtained at different time points during MDE progression represent a promising avenue to discover biological markers for depression.
International vistas on philosophical psychiatry are summarized.Many investigators re-emphasize t... more International vistas on philosophical psychiatry are summarized.Many investigators re-emphasize the continuing relevence for psychopathology of the classical perspectives of Jaspers and Husserl. The Husserlian reduction provides a solid methodological path for psychiatry, psychotherapy, and neurosciences. This presupposes a change in the attitude of the psychiatrist himself.
International vistas on philosophical psychiatry are summarized. Many investigators emphasize the... more International vistas on philosophical psychiatry are summarized. Many investigators emphasize the continuing relevance for psychopathology of the classical perspectives of Jaspers and Husserl. The Husserlian reduction provides a solid methodological path for psychiatry, psychotherapy, and neurosciences. This presupposes a change in the attitude of the psychiatrist himself.
Schizophrenia, like other “pathological” conditions, has not been systematically included in the ... more Schizophrenia, like other “pathological” conditions, has not been systematically included in the general study of consciousness. By focusing on aspects of chronic schizophrenia, we attempt to survey one way of remedying this omission. Some basic components of Edmund Husserl’s phenomenology of human experience (intentionality, synthesis, constitution, epoche, and unbuilding) are explicated in detail, and these components are then employed in an account of exemplary aspects of chronic schizophrenia. We maintain that in schizophrenic experience some very basic constituents of reality – constituents so basic we call them “ontological” – are lost so that the patient must try to explicitly re-constitute those ontological features of the world.
Introduction: Husserlian reduction is a rigorous method for describing the foundations of psychia... more Introduction: Husserlian reduction is a rigorous method for describing the foundations of psychiatric experience. With Jaspers we consider three main principles inspired by phenomenological reduction: direct givenness, absence of presuppositions, re-presentation. But with Binswanger alone we refer to eidetic and transcendental reduction: (1) To establish a critical epistemology; (2) To directly investigate the constitutive processes of mental phenomena and their disturbances, freed from their nosological1 background; (3) To question the constitution of our own experience when facing a person with mental illness. Regarding the last item, we suggest a specific kind of reduction, typically intersubjective from the start, which we call the ‘looking-glass reduction’. The schizophrenic experience — understood as a ‘loss of taken-for-grantedness’ implying the constitutions of the body, of the other, and of internal time — is a real ‘epochal provocation’ for the psychiatrist. As the horizon it opens seems to be both corporeal and narrative, this ‘provoking’ of an epochè in the attitude of the psychiatrist himself and the resistances it implies raise important issues regarding the general constitution of human experience.
In this essay, Wolfgang Blankenburg sketches his influential view that some of the disturbances o... more In this essay, Wolfgang Blankenburg sketches his influential view that some of the disturbances of schizophrenia in particular can be interpreted as a pathology of common sense. We think it important at the outset, however, to avoid possible misunderstandings of Blankenburg’s point. It is perhaps unfortunate that this point is expressed by use of the phrase, “common sense.” As Blankenburg’s own essay shows, even among the learned, “common sense” has no definite or univocal meaning. Therefore, it is entirely possible to find many people who, under some conception of “common sense,” appear to lack common sense and yet should not be deemed schizophrenic. Consequently, it is probably best to avoid the ambiguous phrase “common sense” altogether and seek to comprehend Blankenburg’s point in other terms. That is precisely what we shall attempt here. We do endorse Blankenburg’s view. Moreover, we shall pursue his suggestions that a Husserlian phenomenology of our experience of the life-world may provide the basis for developing the kind of psychopathology he seeks. Our ultimate aim, however, is for this phrase “common sense” to vanish into the Husserlian phenomenology we offer, so that all the other meanings of common sense will not threaten Blankenburg’s position with misunderstandings
Our comments must remain a mere sketch. Since, however, Husserl’s phenomenology is not well known, we shall have to devote some time to outlining those features of it that we deem relevant here.
(French) L'hallucination acoustico-verbale (HAV), ici definie comme compte rendu d'experiences at... more (French) L'hallucination acoustico-verbale (HAV), ici definie comme compte rendu d'experiences attribuees a une voix etrangere en rapport direct avec un trouble de la conscience de soi , est replacee dans son contexte culturel et scientifique. Une attention particuliere est accordee aux modeles cognitivistes, conventionnellement repartis suivant le couple d'opposition Top-Down/Bottom-up. Le reperage de l'HAV comme symptome au sein du dialogue clinique ne peut se passer des histoires scientifiques qui determinent la signification empirique du symptome en tant que tel. Dans ce travail, cette signification empirique est rapportee aux structures neurofonctionnelles cerebrales dans la perspective proposee par Damasio [1]. En distinguant le proto-Soi, le Soi-central et le Soi-autobiographique, Damasio suggere que l'hallucination schizophrenique est un trouble du Soi-autobiographique mais n'elimine pas le fait que ce trouble soit luimeme accompagne d'anomalies du proto-Soi et du Soi-central. Nous confrontons ce modele a l'etude de cas cliniques issue de la phenomenologie. La methode d'analyse de l'experience vive proposee par Damasio, enracinee dans la pensee de James [2], n'est, somme toute, pas tres eloignee de la pratique phenomenologique : on retrouve notamment l'idee fondatrice d'un clivage du sujet faisant apparaitre le sentiment meme de soi qui se tient au fondement de la conscience. Toutefois, la methode phenomenologique suggere de poursuivre l'analyse des anomalies fonctionnelles du sentiment meme de soi en direction de la naturalisation du temps vecu, ce qui fera l'objet d'un prochain travail.
(English) The acoustico-verbal hallucination, defined here as a report of experiences attributed to a foreign voice in direct association with a self-awareness disorder is re-established in its cultural and scientific context. Detailed attention is given to the cognitive models, conventionally divided according to the opposites Top-Down/Bottom-Up. Identifying the acoustico-verbal hallucination as a symptom within the clinical dialogue cannot occur from the scientific stories which determine the empirical significance of the symptom as such. In this work, this empirical significance is associated with the cerebral neurofunctional structures from the perspective of Damasio. By distinguishing the proto-Self, the central-Self and the autobiographical-Self, Damasio suggested that the schizophrenic hallucination is a disorder of the autobiographical-Self, but this fact does not preclude that this disorder itself is accompanied by anomalies of the proto-Self and of the central-Self. We challenge this model with the clinical case study resulting from phenomenology. The method of analysis of the experiment suggested by Damasio, rooted in the reflection of James, is not, altogether, very far from the phenomenological practice: one finds notably the idea of a division of the subject revealing self-awareness which is at the foundation of conscience. However, the phenomenological method suggests a continuation of the functional anomalies of self-awareness towards the naturalization of lived time, which will be the subject of a forthcoming work.
O movimento desalienista, termo que devemos ao psiquiatra francês Lucien Bonnafé, aglomera um con... more O movimento desalienista, termo que devemos ao psiquiatra francês Lucien Bonnafé, aglomera um conjunto muito heterogêneo de movimentos intelectuais, clínicos e políticos visando pôr em questão a instituição psiquiátrica a partir da segunda metade do século XX. Na França, este movimento assumiu um lugar significativo no pensamento psiquiátrico após a segunda guerra mundial. Pode-se reunir nesta vanguarda os movimentos da antipsiquiatria e a psicoterapia instituicional. O movimento da psicoterapia institucional nasceu da constatação que a instituição psiquiátrica, se ela não faz o objeto de uma reflexão crítica e clínica constante, pode ser responsável pelo agravamento das doenças mentais e, em primeiro lugar, das psicoses graves. Esta constatação tomou uma dimensão trágica durante a segunda guerra mundial quando aproximadamente 40 000 doentes mentais sucumbiram à fome nos hospitais psiquiátricos franceses de 1940 a 1944. Este resultado se explica, em parte, pela indiferença e esquecimento contra os quais não se levantaram mais que raros protestos. Se, ao final da guerra, estas constatações vão mobilizar a vanguarda psiquiátrica, o movimento da psicoterapia institucional e aquele da antipsiquiatria farão escolhas teóricas e políticas diferentes. Notadamente, sobre a questão espinhosa da natureza das doenças mentais. O objeto dessa intervenção será de tentar fazer dialogar estas duas correntes a partir do que as enraízam comumente na fenomenologia.
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Papers by Jean Naudin
requires a comprehensive method, understood as a systematic
exploration of the first-person perspective of the patient’s
experience. At the same time, however, schizophrenia
for Jaspers is characterized by its radical incomprehensibility.
In addition, Rümke’s so-called “praecox feeling”
paradoxically combines the incomprehensibility of schizophrenic
experience and the evidence of its pathological
manifestation in the encounter. Aim: Through a re-examination
of the notions of affectivity and interaffective contact
we propose a coherent theoretical model to explain the clinician’s
paradoxical understanding of schizophrenia. Method:
Phenomenological tradition regards affectivity as an encompassing
phenomenon that connects body, self, world,
and others. In our view, only a thorough and systematic link
between corporeity and affectivity is able to explain embodied affective resonance as a basis of empathic comprehension.
By drawing on the phenomenology of Marc Richir,
we will systematically unfold the complex nature of affectivity
and lead it back to a twofold constitution of corporeality.
Conclusion: The Richirian account on affectivity can be
fruitfully put into discussion with other recent phenomenological
models on schizophrenia. It might be able to exhibit
affectivity as the operative ground of minimal self-disturbance
and thus argue for its intersubjective dimension.
requires a comprehensive method, understood as a systematic
exploration of the first-person perspective of the patient’s
experience. At the same time, however, schizophrenia
for Jaspers is characterized by its radical incomprehensibility.
In addition, Rümke’s so-called “praecox feeling”
paradoxically combines the incomprehensibility of schizophrenic
experience and the evidence of its pathological
manifestation in the encounter. Aim: Through a re-examination
of the notions of affectivity and interaffective contact
we propose a coherent theoretical model to explain the clinician’s
paradoxical understanding of schizophrenia. Method:
Phenomenological tradition regards affectivity as an encompassing
phenomenon that connects body, self, world,
and others. In our view, only a thorough and systematic link
between corporeity and affectivity is able to explain embodied affective resonance as a basis of empathic comprehension.
By drawing on the phenomenology of Marc Richir,
we will systematically unfold the complex nature of affectivity
and lead it back to a twofold constitution of corporeality.
Conclusion: The Richirian account on affectivity can be
fruitfully put into discussion with other recent phenomenological
models on schizophrenia. It might be able to exhibit
affectivity as the operative ground of minimal self-disturbance
and thus argue for its intersubjective dimension.
Our comments must remain a mere sketch. Since, however, Husserl’s phenomenology is not well known, we shall have to devote some time to outlining those features of it that we deem relevant here.
(English) The acoustico-verbal hallucination, defined here as a report of experiences attributed to a foreign voice in direct association with a self-awareness disorder is re-established in its cultural and scientific context. Detailed attention is given to the cognitive models, conventionally divided according to the opposites Top-Down/Bottom-Up. Identifying the acoustico-verbal hallucination as a symptom within the clinical dialogue cannot occur from the scientific stories which determine the empirical significance of the symptom as such. In this work, this empirical significance is associated with the cerebral neurofunctional structures from the perspective of Damasio. By distinguishing the proto-Self, the central-Self and the autobiographical-Self, Damasio suggested that the schizophrenic hallucination is a disorder of the autobiographical-Self, but this fact does not preclude that this disorder itself is accompanied by anomalies of the proto-Self and of the central-Self. We challenge this model with the clinical case study resulting from phenomenology. The method of analysis of the experiment suggested by Damasio, rooted in the reflection of James, is not, altogether, very far from the phenomenological practice: one finds notably the idea of a division of the subject revealing self-awareness which is at the foundation of conscience. However, the phenomenological method suggests a continuation of the functional anomalies of self-awareness towards the naturalization of lived time, which will be the subject of a forthcoming work.