1
|
Monteiro V, Bloc L, Messas G. What Is It Like to Be in Alcohol Addiction Recovery? A Dialectical Phenomenological Analysis. Psychopathology 2024:1-12. [PMID: 38754403 DOI: 10.1159/000538267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Currently, there is no scientific consensus on the concept of alcohol addiction recovery beyond substance use control. This conceptual issue challenges the implementation of therapeutic strategies and mental health policies that are unrestricted to symptomatic remission. Aiming to contribute to its definition, this study aimed to examine the recovery experience of individuals with alcohol addiction using dialectical phenomenological psychopathology (DPP) as a theoretical and methodological framework. METHODS A dialectical phenomenological analysis was conducted through an examination of online interviews with eight Brazilian, São Paulo state citizens who were self-declared to be undergoing alcohol addiction recovery (or who declared that they had completely recovered). RESULTS Participants' reports generated eight categories that were subdivided into two groups. The first group indicated experiential elements of recovery, such as changes in self-relation, changes in interpersonal relations, and changes in time relations, giving new meanings to suffering and alcohol use, and recovery as a continuous process. The second group referred to how the participants interpreted recovery according to their worldviews: as a spiritual experience, moral reformation, and mentality change. CONCLUSION These categories can be understood through the lens of DPP as a process of change in the subjects' being in the world, characterized by the continued management of their existential imbalances in the dimensions of spatiality, temporality, selfhood, and intersubjectivity. The results are preliminary when it comes to conceptualizing recovery but may help future studies to develop recovery-oriented therapeutic strategies.
Collapse
Affiliation(s)
- Victor Monteiro
- Department of Mental Health, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Lucas Bloc
- Postgraduate Program in Psychology, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Guilherme Messas
- Department of Mental Health, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College, Oxford, UK
| |
Collapse
|
2
|
Ricci V, Maina G, Martinotti G. The Loss of Spatiality and Temporality in Twilight Consciousness: The Emergence of Exogenous Psychosis Induced by Novel Psychoactive Substances. Psychopathology 2024; 57:248-258. [PMID: 38631303 DOI: 10.1159/000536076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/29/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND The state of twilight consciousness is marked by a focused narrowing of awareness, maintaining vigilance and attention while simultaneously experiencing perceptual shifts in the surrounding environment. It is crucial to recognize that this twilight state represents not just a contraction but also an expansion of conscious experience. SUMMARY Substances of abuse, particularly new psychoactive substances, play a significant role in inducing this twilight state. They achieve this by deconstructing essential components of consciousness, such as the perception of time and space. KEY MESSAGE This paper aimed to explore the phenomenon of the twilight state of consciousness and shed light on how new psychoactive substances can alter the perception of time and space during this twilight phase, potentially triggering exogenous psychosis. This comprehensive inquiry employs a phenomenological approach to the study of consciousness, recognizing it as the primary tool for ascribing significance to this intricate yet often overlooked aspect of psychopathology.
Collapse
Affiliation(s)
- Valerio Ricci
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Maina
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università Degli Studi G. D'Annunzio Chieti-Pescara, Chieti, Italy
| |
Collapse
|
3
|
Ricci V, Maina G, Martinotti G. Dissociation and Temporality in Substance Abuse: A Clinical Phenomenological Overview. Psychopathology 2023; 57:219-228. [PMID: 37903485 DOI: 10.1159/000533862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/26/2023] [Indexed: 11/01/2023]
Abstract
The term "dissociation" encompasses a wide array of symptoms and phenomena, all sharing the common characteristic of involving altered states of consciousness where an individual temporarily loses the sense of continuity of their own identity. In the context of addiction pathology, however, the dissociative paradigm remains a topic of ongoing debate. It fluctuates between the description of individual dissociative symptoms and the notion of post-traumatic dissociation as a structural process. This process involves fragmentation that extends beyond the confines of perception and experience within a singular moment, instead ensuring a persistent discontinuity of the self throughout one's existence. Pathological addiction stresses the question of the donation of sense in this deep and dramatic experience; it situates individuals within a compressed and constricted realm of vital space, alongside a frozen perception of time. Within this context, every emotion, sensation, and comprehension becomes impaired. Consequently, we have embarked on a journey starting with a historical analysis: the aim was to construct an elucidative framework for the dissociative paradigm in the context of addiction. This involves an in-depth exploration of the fundamental constructs of trauma and temporality, examined through the lens of phenomenological perspective.
Collapse
Affiliation(s)
- Valerio Ricci
- Department of Psychiatry, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Maina
- Department of Psychiatry, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università Degli Studi G. D'Annunzio Chieti-Pescara, Chieti, Italy
| |
Collapse
|
4
|
Messas G, Stanghellini G, Fulford KWM(B. Phenomenology yesterday, today, and tomorrow: a proposed phenomenological response to the double challenges of contemporary recovery-oriented person-centered mental health care. Front Psychol 2023; 14:1240095. [PMID: 37809297 PMCID: PMC10551134 DOI: 10.3389/fpsyg.2023.1240095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
This paper argues that a dialectical synthesis of phenomenology's traditional twin roles in psychiatry (one science-centered, the other individual-centered) is needed to support the recovery-oriented practice that is at the heart of contemporary person-centered mental health care. The paper is in two main sections. Section I illustrates the different ways in which phenomenology's two roles have played out over three significant periods of the history of phenomenology in 20th century psychiatry: with the introduction of phenomenology in Karl Jaspers' General Psychopathology in 1913; with the development a few years later of structural phenomenological psychopathology; and in the period of post-War humanism. Section II is concerned with the role of phenomenology in contemporary mental health. There has been a turn to phenomenology in the current period, we argue, in response to what amounts to an uncoupling of academic psychiatry from front-line clinical care. Corresponding with the two roles of phenomenology, this uncoupling has both scientific aspects and clinical aspects. The latter, we suggest, is most fully expressed in a new model of "recovery," defined, not by the values of professionals as experts-by-training, but by the values of patients and carers as experts-by-experience, specifically, by what is important to the quality of life of the individual concerned in the situation in question. We illustrate the importance of recovery, so defined, and the challenges raised by it for both the evidence-base and the values-base of clinical decision-making, with brief clinical vignettes. It is to these challenges we argue, that phenomenology through a synthesis of its twin roles is uniquely equipped to respond. Noting, however, the many barriers to such a synthesis, we argue that in the current state of development of the field, it is by way of a dialectical synthesis of phenomenology's roles that we should proceed. From such a dialectic, a genuine synthesis of roles may ultimately emerge. We conclude with a note on the wider significance of these developments, arguing that contrary to 20th century stereotypes, they show psychiatry to be leading the way for healthcare as a whole, in developing the resources for 21st century person-centered clinical care.
Collapse
Affiliation(s)
- Guilherme Messas
- Department of Mental Health, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
- The Collaborating Centre for Values-Based Practice, St Catherine’s College, Oxford, United Kingdom
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- ‘D. Portales’ University, Santiago, Chile
| | - K. W. M. (Bill) Fulford
- The Collaborating Centre for Values-Based Practice, St Catherine’s College, Oxford, United Kingdom
- St Catherine’s College, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
- Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
5
|
Fukuda L, Tamelini M, Messas G. Obsessive-compulsive existential type: a dialectical-phenomenological approach. Front Psychol 2023; 14:1211598. [PMID: 37736151 PMCID: PMC10509482 DOI: 10.3389/fpsyg.2023.1211598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023] Open
Abstract
The clinical presentation of obsessive-compulsive patients is characterized by unwanted, intrusive, nonsensical, self-related, and recurrent ideas, thoughts, images, or impulses associated with active compulsive compensations. Under the operational diagnostic criteria adopted by the biological- and cognitive-oriented neopositivist medical paradigm, it is known as "obsessive-compulsive disorder." However, this paradigm has been criticized for its controversial assumptions, limited methodologies, theoretic biases, and inconsistency in producing practical outcomes. To bypass some of these issues, we propose a complementary approach that draws on and further develops existing psychopathological studies of the obsessive-compulsive anthropological condition based on dialectical phenomenological psychopathology. As such, we refer to the global clinical configuration as the "obsessive-compulsive existential type." Our theoretical inspiration comes from the classical phenomenological work on obsessions undertaken by Straus and Gebsattel, which identified the negative transformation of the obsessive-compulsive life-world or the endogenous emergence of the anti-eidos (diluting existential force). We then propose to broaden the concept of anti-eidos, especially in its dialectical correlation with eidos (unifying existential force), representing the existential dialectic between transformation and permanence. Next, we detail the dynamics of anthropological disproportions in obsessive-compulsive existential type, essentially the supremacy of the anti-eidos over the eidos. This primary imbalance modifies the obsessive-compulsive existential structure, consisting of polymorphic temporality; weakened intentionality; maladjusted calibration of distance with the world and others; an integral, isolated, besieged self with dwindling self-agency, and tense and over-protecting embodiment. We also analyze compensatory hyperreflexivity and compulsive rituals as expressions of structural counterbalancing designed to contain the primary structural disproportions and derangements. The heterogeneous obsessive-compulsive clinical manifestations are the complex result of the primary structural alteration and subsequent phenomenological compensations. They tend to be variable in temporal span and rarely assume a fixed form, hindering diagnosis. We correlate structural frameworks with multiple clinical examples. Finally, we raise some insights on how our study may contribute to scientific research and therapeutic proposals.
Collapse
Affiliation(s)
- Lívia Fukuda
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Melissa Tamelini
- Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Messas
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- The Collaborating Center for Values-Based Practice, St Catherine’s College, Oxford, United Kingdom
| |
Collapse
|
6
|
Larsen RR, Maschião LF, Piedade VL, Messas G, Hastings J. More phenomenology in psychiatry? Applied ontology as a method towards integration. Lancet Psychiatry 2022; 9:751-758. [PMID: 35817066 DOI: 10.1016/s2215-0366(22)00156-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/25/2022] [Accepted: 04/22/2022] [Indexed: 12/21/2022]
Abstract
There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry have been met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges.
Collapse
Affiliation(s)
- Rasmus R Larsen
- Department of Philosophy, University of Toronto Mississauga, Mississauga, ON, Canada; Forensic Science Program, University of Toronto Mississauga, Mississauga, ON, Canada.
| | - Luca F Maschião
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Valter L Piedade
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Guilherme Messas
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Janna Hastings
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK; Institute for Intelligent Interacting Systems, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
7
|
Fusar-Poli P, Estradé A, Stanghellini G, Venables J, Onwumere J, Messas G, Gilardi L, Nelson B, Patel V, Bonoldi I, Aragona M, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Tamelini MG, Maschião LF, Puchivailo MC, Piedade VL, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Kuipers E, Arango C, Maj M. The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2022; 21:168-188. [PMID: 35524616 PMCID: PMC9077608 DOI: 10.1002/wps.20959] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud-based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self-referentiality and permeated self-world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re-establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
Collapse
Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Giovanni Stanghellini
- Department of Psychological, Territorial and Health Sciences, "G. d'Annunzio" University, Chieti, Italy
- Center for Studies on Phenomenology and Psychiatry, Medical Faculty, "D. Portales" University, Santiago, Chile
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Juliana Onwumere
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Guilherme Messas
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Ana Cabrera
- Asociación Española de Apoyo en Psicosis, Madrid, Spain
| | - Joseba Rico
- Asociación Española de Apoyo en Psicosis, Madrid, Spain
| | - Arif Hoque
- Young Person's Mental Health Advisory Group (YPMHAG), King's College London, London, UK
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group (YPMHAG), King's College London, London, UK
| | - Nicholas Hunter
- NHS South London and Maudsley (SLaM) Recovery College, London, UK
| | - Melissa G Tamelini
- Institute of Psychiatry, Hospital das Clínicas de São Paulo, São Paulo, Brazil
| | - Luca F Maschião
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Mariana Cardoso Puchivailo
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Psychology, FAE University Center, Curitiba, Brazil
| | - Valter L Piedade
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), Brussels, Belgium
| | - Lily Kpodo
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Jianan Bao
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Forensic and Neurodevelopment Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- School of Medicine, Keele University, Staffordshire, UK
| | - Elizabeth Kuipers
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| |
Collapse
|
8
|
Messas G, Fukuda L, Fulford KWM. The Dialectics of Altered Experience: How to Validly Construct a Phenomenologically Based Diagnosis in Psychiatry. Front Psychiatry 2022; 13:867706. [PMID: 35492704 PMCID: PMC9039225 DOI: 10.3389/fpsyt.2022.867706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
In this paper, we present how a dialectical perspective on phenomenological psychopathology, called Dialectical Phenomenology (DPh), can contribute to current needs of psychiatric diagnosis. We propose a three-stage diagnostic methodology: first- and second-person stages, and synthetic hermeneutics stage. The first two stages are divided into a pre-dialectical and a dialectical phase. The diagnostic process progresses in a trajectory of increasing complexity, in which knowledge obtained at one level is dialectically absorbed and intertwined into the next levels. Throughout the article, we offer some examples of each step. In overall, the method starts off from the patient's own narrative, proceeds to two stages of phenomenological reduction designed to guarantee the scientific validity of the object, and concludes with a hermeneutical narrative synthesis that is dialectically composed of the patient's and psychopathologist's shared narratives. At the end of this process, the initial first-person narrative is transformed into a specific scientific object, a full dialectical phenomenological psychiatric diagnosis. This form of diagnosis constitutes a comprehensive alternative for an integral assessment of the complexities of human psychological alteration, bringing together both the interpretation of the suffering person and the scientific categories of psychiatry.
Collapse
Affiliation(s)
- Guilherme Messas
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.,Collaborating Centre for Values-Based Practice, St Catherine's College, Oxford, United Kingdom
| | - Lívia Fukuda
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - K W M Fulford
- Collaborating Centre for Values-Based Practice, St Catherine's College, Oxford, United Kingdom.,Philosophy Faculty, St Catherine's College, University of Oxford, Oxford, United Kingdom.,Philosophy and Mental Health, University of Warwick, Coventry, United Kingdom
| |
Collapse
|