Autopraxis, Desaktualisierung, Aktivierung und die Willensthematik

Operationalisierte, kriteriengeleitete Beurteilung der Schuldfähigkeit bei paraphilen Störungen – Stand und Ausblick

Die vorliegende Arbeit beschäftigt sich mit der operationalisierten, kriteriengeleiteten Beurteilung für die Begutachtung der Schuldfähigkeit bei paraphilen Störungen. Zunächst werden frühere Überlegungen und Ansätze dargestellt und um neue empirische, vorläufige Ergebnisse, welche erste Annahmen zu Reliabilität und Validität des Vorgehens ermöglichen, erweitert. Anschließend werden kurz die Ergebnisse einer Expertendiskussion zum Thema ergänzt, um vorläufige Schlussfolgerungen und einen Ausblick darzustellen. Insgesamt wird mit der operationalisierten, kriteriengeleiteten Beurteilung für die Begutachtung der Schuldfähigkeit bei paraphilen Störungen ein Verfahren vorgeschlagen, das als vielversprechend angesehen werden kann und zu einer Erweiterung des Vorgehens, den weiteren interdisziplinären Dialog und die weitere empirische Prüfung animiert.

[Disorders of the will in psychopathology]

At the beginning of modern psychopathology the notion of the will had a high significance. Thus, the works of Eugen Bleuler, Emil Krapelin and Karl Jaspers show an intensive study of disorders of the will, such as abulia, ambivalence or disorders of impulse control. Retrospectively, changes of the scientific paradigms in psychology could be one of the reasons for a break, which led to giving up the concept of the will in psychopathology. With increasing interest in issues of agency and free will, however, a reactivation of this central concept could close a gap in psychopathology as well as in therapeutic practice. Methodologically, a psychopathology of the will may be founded on a differential typological phenomenology. To this purpose, the article first proposes a classification along the structural components of conation, suspension and volition, then gives a temporal analysis of the predecisional, the decisional and the postdecisional phases. The aim of the article is to help identify different disorders of the will, thus also furthering a psychotherapy of will, which can be connected with both cognitive behavioral and psychodynamic approaches.

[On schizophrenic passivity]

Using a case history this paper attempts to define a certain temporal orientation peculiar to schizophrenic passivity. In agreement with Straus, we divide the present into two modes, one before confirmation of an action and one after. The former mode is termed the immediate present, and the latter is the nonimmediate present. Due to the requirement of recording procedure in neuroscience, it usually is unable to deal with questions of the immediate present. This leads to a"discovery" that cerebral initiation of a voluntary act arises prior to our conscious awareness of the intention to act. Such a belated awareness could be also found in"made" actions of schizophrenia, because a patient becomes aware of alien control only after a movement of his body has been caused by external agencies. With regard to this resemblance schizophrenic passivity may be conceived as a disturbance of anchorage in the immediate present. Taking account of an anthropological concept of"life" we elucidate the relationship of the self to the immediate present.

Der strukturdynamische Ansatz

Concepts based on brain structure and function with a tendency towards elimination of the subject have assumed a position of central importance in modern psychiatry. With respect to structural dynamics, the primary role in relating to others is played by each person's internal world. Psychic structure is a precondition of our intentions and personal identity. In psychopathology the three basic functions autopractice, desactualisation, and activation had been differentiated as contributing to the psyche as a whole. Their application is expanded to an anthropological conceptualisation.

The temporal structure of intentionality and its disturbance in schizophrenia

Working memory, attention and executive control functions are central areas of neuropsychological research in schizophrenia. These concepts implicitly refer to the basic temporal structure of mental life as an integration of past, present and future. From a phenomenological point of view, they may be paralleled to the structure of internal time consciousness as analyzed by Husserl, consisting of a retentional, presentational and protentional function. These synthetic functions, operating at the most basic layer of consciousness, are capable of integrating the sequence of single moments into an 'intentional arc', enabling us to direct ourselves towards objects and goals in a meaningful way. On this background, basic symptoms of schizophrenia such as formal thought disorder, loss of automatic performances and disturbances of self-awareness may be conceived as caused by a weakening and dissolution of the intentional arc. A failure of the continuous intertwining of succeeding moments, and especially of the protentional function, leads to a loss of the tacit or operative intentionality that carries the acts of perceiving, thinking and acting. The loss of tacit, implicit functions undermines the common-sensical understanding of reality and has to be compensated by the deliberate, hyperreflexive reconstruction of everyday performances. Phenomenological analyses may thus establish a link between experimental research on single mental dysfunctions on the one hand and the higher level of the patient's subjective experience on the other.

Psychotherapie in den Lebenswissenschaften

In the 150 years since psychotherapies were theoretically founded and first practised, changes have occurred in the understanding of humans from concepts based on physical sciences to concepts rooted in biologic life sciences. Biopsychosocial knowledge of the way human nature links with environmental factors has resulted in new views on the causes of psychological disorders and the tasks of psychotherapy. The main selective processes of adjustment to the environment take place with genetic variations between the 6th and 20th years of life and in further developments until death. Psychotherapy has to overcome pathologically distorted impressions of the environment. Latent abilities and neglected options need to manifest themselves for patients to find a new outlook on life.