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Sass L, Feyaerts J. Schizophrenia, the very idea: On self-disorder, hyperreflexivity, and the diagnostic concept. Schizophr Res 2024; 267:473-486. [PMID: 38693032 DOI: 10.1016/j.schres.2024.03.022] [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: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 05/03/2024]
Abstract
The purpose of the present article is to consider schizophrenia-the very idea-from the perspective of phenomenological psychopathology, with special attention to the problematic nature of the diagnostic concept as well as to the prospect and challenges inherent in focusing on subjective experience. First, we address historical and philosophical topics relevant to the legitimacy of diagnostic categorization-in general and regarding "schizophrenia" in particular. William James's pragmatist approach to categorization is discussed. Then we offer a version of the well-known basic-self or ipseity-disturbance model (IDM) of schizophrenia, but in a significantly revised form (IDMrevised). The revised model better acknowledges the diverse and even seemingly contradictory nature of schizophrenic symptoms while, at the same time, interpreting these in a more unitary fashion via the key concept of hyperreflexivity-a form of exaggerated self-awareness that tends to undermine normal world-directedness and the stability of self-experience. Particular attention is paid to forms of exaggerated "self-presence" that are sometimes neglected yet imbue classically schizophrenic experiences involving subjectivism or quasi-solipsism and/or all-inclusive or ontological forms of paranoia. We focus on the distinctively paradoxical nature of schizophrenic symptomatology. In concluding we consider precursors in the work of Klaus Conrad, Kimura Bin and Henri Grivois. Finally we defend the concept of schizophrenia by considering its distinctive way of altering certain core aspects of the human condition itself.
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Affiliation(s)
- Louis Sass
- Dept of Clinical Psychology, GSAPP-Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Jasper Feyaerts
- Dept of Psychoanalysis & Clinical Consulting, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.
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2
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Olarewaju E, Dumas G, Palaniyappan L. Disorganized Communication and Social Dysfunction in Schizophrenia: Emerging Concepts and Methods. Curr Psychiatry Rep 2023; 25:671-681. [PMID: 37740852 DOI: 10.1007/s11920-023-01462-4] [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] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW In this review, we embrace the emerging field of second-person neuroscience to address disorganization in schizophrenia. We argue that the focus of interest for disorganization is the interpersonal space where shared mental processes ('social mind') occur based on the bio-behavioural synchrony between two (or more) interacting people. We lay out several bio-behavioural measures that can capture the component parts of this process. In particular, we highlight the real-time imaging technology of hyperscanning that enables multi-person analysis of naturalistic social interaction. We illustrate how these measures can be used in empirical studies by posing disorganization as a problem of interpersonal processing. RECENT FINDINGS Traditionally, disorganized speech and behaviour have been studied as the product of hidden cognitive processes ('private mind'). A dysfunction in these processes was attributed to the brain afflicted by the illness ('brain-bound mechanisms'). But this approach has contributed to challenges in measuring and quantifying disorganization. Consequently, the single-brain focus has not provided satisfactory clarity or led to effective treatments for persistent social dysfunction in schizophrenia. Social dysfunction is a core feature of schizophrenia. This dysfunction arises from disorganized interpersonal interaction that typifies the social profile of affected individuals. We outline challenges in employing several emerging concepts and methods and how they can be addressed to investigate the mechanisms of social dysfunction in schizophrenia.
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Affiliation(s)
- Emmanuel Olarewaju
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Guillaume Dumas
- Department of Psychiatry, CHU Sainte Justine Research Center, University of Montreal, Montreal, QC, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
- Robarts Research Institute, Western University, London, ON, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
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3
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Wendler H, Fuchs T. Understanding incomprehensibility: Misgivings and potentials of the phenomenological psychopathology of schizophrenia. Front Psychol 2023; 14:1155838. [PMID: 37057153 PMCID: PMC10086155 DOI: 10.3389/fpsyg.2023.1155838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Hannes Wendler
- Department of Philosophy, University of Cologne, Cologne, Germany
- *Correspondence: Hannes Wendler
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychiatry, University Clinic Heidelberg, Heidelberg, Germany
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Lucarini V, Cangemi F, Daniel BD, Lucchese J, Paraboschi F, Cattani C, Marchesi C, Grice M, Vogeley K, Tonna M. Conversational metrics, psychopathological dimensions and self-disturbances in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:997-1005. [PMID: 34476588 DOI: 10.1007/s00406-021-01329-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
Difficulties in interpersonal communication, including conversational skill impairments, are core features of schizophrenia. However, very few studies have performed conversation analyses in a clinical population of schizophrenia patients. Here we investigate the conversational patterns of dialogues in schizophrenia patients to assess possible associations with symptom dimensions, subjective self-disturbances and social functioning. Thirty-five schizophrenia patients were administered the Positive and Negative Syndrome Scale (PANSS), the Clinical Language Disorder Rating Scale (CLANG), the Scale for the Assessment of Thought, Language and Communication (TLC), the Examination of Anomalous Self-Experience Scale (EASE), and the Social and Occupational Functioning Assessment Scale (SOFAS). Moreover, participants underwent a recorded semi-structured interview, to extract conversational variables. Conversational data were associated with negative symptoms and social functioning, but not with positive or disorganization symptoms. A significant positive correlation was found between "pause duration" and the EASE item "Spatialization of thought". The present study suggests an association between conversational patterns and negative symptom dimension of schizophrenia. Moreover, our findings evoke a relationship between the natural fluidity of conversation and of the natural unraveling of thoughts.
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Affiliation(s)
- Valeria Lucarini
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy.
| | | | | | - Jacopo Lucchese
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
| | - Francesca Paraboschi
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
| | - Chiara Cattani
- Department of Statistical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carlo Marchesi
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
| | - Martine Grice
- IfL-Phonetics, University of Cologne, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Matteo Tonna
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
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5
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Gozé T. How to Teach/Learn Praecox Feeling? Through Phenomenology to Medical Education. Front Psychiatry 2022; 13:819305. [PMID: 35370862 PMCID: PMC8971516 DOI: 10.3389/fpsyt.2022.819305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Praecox Feeling (PF) refers to a classical psychopathological concept describing the specific experience of bizarreness arising in the encounter with a person living with schizophrenia spectrum disorders (SSDs). Some studies have shown that experienced psychiatrists take advantage of this experience to perform accurate and rapid diagnostic expertise. It would seem that PF is not contradictory with an operationalized diagnostic approach, but that the PF would intervene at a more tacit level of medical judgment. However, the articulation between the implicit and explicit levels of the psychiatrist's experience in the situation of medical judgment remains little studied, even though it is of crucial importance for structuring the teaching of clinical psychiatry to mental health practitioners. Can diagnostic intuition be learned? Is this experience a kind of "gift" that some may or may not have? Does the PF refer to medical expertise? METHODS To unfold the complexity of his questions this article proposes to conduct an historical, epistemological and phenomenological analysis of the PF. RESULTS We will first conduct a presentation of historical descriptions of the PF understood as a sensation, intuition and experience, alongside the evolution of the concept of schizophrenia. Then, the article proposes an original phenomenological modelization of the temporal unfolding of the PF. DISCUSSION The phenomenological conceptualization, informed from empirical evidence will try to account for the paradox of the PF as both lived evidence and indescribable experience. PF will be described as a complex cognitive and embodied process based upon ante-predicative aesthetic sensing which is secondly apprehended as perceptible evidence thanks to clinical typification. This conceptualization relying on Husserl manuscript on intersubjectivity will help to demystify its experiential structure and discuss its relevance for medical education.
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Affiliation(s)
- Tudi Gozé
- Department of Psychiatry, Psychotherapies, Art-therapy, Toulouse University Hospital, Toulouse, France.,Equipe de Recherche sur les Rationalités Philosophiques et les Savoirs - EA3051, Université de Toulouse - Jean Jaurès, Toulouse, France
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6
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Hashimoto R. Do eye movement abnormalities in schizophrenia cause Praecox Gefühl? Psychiatry Clin Neurosci 2021; 75:79-80. [PMID: 33694238 DOI: 10.1111/pcn.13197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Moskalewicz M, Kordel P, Brejwo A, Schwartz MA, Gozé T. Psychiatrists Report Praecox Feeling and Find It Reliable. A Cross-Cultural Comparison. Front Psychiatry 2021; 12:642322. [PMID: 33746799 PMCID: PMC7973011 DOI: 10.3389/fpsyt.2021.642322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The psychopathological notion of the Praecox Feeling (PF) refers to an experience of strangeness and bizarreness that arises in a clinician during contact with a patient with schizophrenia. There is evidence that psychiatrists take advantage of this feeling in their diagnostic decisions despite the domination of an operationalized diagnostic approach. Methods: The article presents the results of a survey assessing the self-reported prevalence of the PF among psychiatrists in Poland and compares them with data from West Germany (1962), USA (1989), and France (2017) based on the same survey. Results: The study finds a consistent prevalence of reported feelings suggestive of the diagnosis of schizophrenia among psychiatrists of different cultural backgrounds and times. These feelings are independent of variables such as attitude toward schizophrenia, professional orientation, and professional experience and are considered reliable, even if not the most reliable, by the psychiatrists who have them. The study also finds that intersubjective phenomena, such as problematic affective attunement, gestures, and body language, are considered core to these feelings by the psychiatrists. Conclusions: The evidence confirms that psychiatrists' feelings about patients with schizophrenia are considered diagnostically relevant and calls for more deeply investigating the nature and diagnostic significance of these feelings. The article concludes with some speculations regarding the possible benefits of recognizing the PF in facilitating a psychotherapeutic encounter with psychotic patients.
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Affiliation(s)
- Marcin Moskalewicz
- Philosophy of Mental Health Unit, Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Kordel
- Philosophy of Mental Health Unit, Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Michael A Schwartz
- Texas A&M Health Science Center College of Medicine, Round Rock, TX, United States
| | - Tudi Gozé
- Department of Psychiatry, Psychotherapies, Art Therapy, Toulouse University Hospital, Toulouse, France.,Equipe de Recherche sur les Rationalités Philosophiques et les Savoirs (ERRaPhiS-EA 3051), Toulouse University-Jean Jaurès, Toulouse, France
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8
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Erratum: A Phenomenological Paradigm for Empirical Research in Psychiatry and Psychology: Open Questions. Front Psychol 2020; 11:1989. [PMID: 32793088 PMCID: PMC7392044 DOI: 10.3389/fpsyg.2020.01989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
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Irarrázaval L. A Phenomenological Paradigm for Empirical Research in Psychiatry and Psychology: Open Questions. Front Psychol 2020; 11:1399. [PMID: 32670164 PMCID: PMC7330133 DOI: 10.3389/fpsyg.2020.01399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
This article seeks to clarify the way in which phenomenology is conceptualized and applied in empirical research in psychiatry and psychology, emphasizing the suitability of qualitative research. It will address the “What,” “Why,” and “How” of phenomenological interviews, providing not only preliminary answers but also a critical analysis and pointing to future directions for research. The questions it asks are: First, what makes an interview phenomenological? What are phenomenological interviews used for in empirical research in psychiatry and psychology? Second, why do we carry out phenomenological interviews with patients? Is merely contrasting phenomenological hypotheses or concepts enough to do justice to the patients’ involvement? Third, how should we conduct phenomenological interviews with patients? How can we properly perform analysis in empirical phenomenological research in psychiatry and psychology? In its conclusion, the article attempts to go a step beyond these methodological questions, highlighting the “bigger picture”: namely, the phenomenological scientific paradigm and its core philosophical claim of reality as mind-dependent.
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Affiliation(s)
- Leonor Irarrázaval
- Section Phenomenological Psychopathology and Psychotherapy, Psychiatric Department, University Clinic Heidelberg, Heidelberg, Germany.,Centro de Atención Psicológica, Facultad de Ciencias Sociales y Humanidades Sede Talca, Universidad Autónoma de Chile, Talca, Chile
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10
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"Social physiology" for psychiatric semiology: How TTOM can initiate an interactive turn for computational psychiatry? Behav Brain Sci 2020; 43:e102. [PMID: 32460917 DOI: 10.1017/s0140525x19002735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thinking through other minds (TTOM) encompasses new dimensions in computational psychiatry: social interaction and mutual sense-making. It questions the nature of psychiatric manifestations (semiology) in light of recent data on social interaction in neuroscience. We propose the concept of "social physiology" in response to the call by the conceivers of TTOM for the renewal of computational psychiatry.
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11
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Hayes J, McCabe R, Ford T, Russell G. Drawing a line in the sand: affect and testimony in autism assessment teams in the UK. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:825-843. [PMID: 32086837 PMCID: PMC7317870 DOI: 10.1111/1467-9566.13063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diagnosis of autism in the UK is generally made within a multidisciplinary team setting and is primarily based on observation and clinical interview. We examined how clinicians diagnose autism in practice by observing post-assessment meetings in specialist autism teams. Eighteen meetings across four teams based in the south of England and covering 88 cases were audio-recorded, transcribed and analysed using thematic analysis. We drew out two themes, related to the way in which clinicians expressed their specialist disciplinary knowledge to come to diagnostic consensus: Feeling Autism in the Encounter; and Evaluating Testimonies of Non-present Actors. We show how clinicians produce objective accounts through their situated practices and perform diagnosis as an act of interpretation, affect and evaluation to meet the institutional demands of the diagnostic setting. Our study contributes to our understanding of how diagnosis is accomplished in practice.
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Affiliation(s)
- Jennie Hayes
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Rose McCabe
- School of Health Sciences, CityUniversity of LondonLondonUK
| | - Tamsin Ford
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Ginny Russell
- Colleges of Medicine and Health/Social Sciences and International StudiesUniversity of ExeterExeterUK
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12
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Dupuy L, Micoulaud-Franchi JA, Cassoudesalle H, Ballot O, Dehail P, Aouizerate B, Cuny E, de Sevin E, Philip P. Evaluation of a virtual agent to train medical students conducting psychiatric interviews for diagnosing major depressive disorders. J Affect Disord 2020; 263:1-8. [PMID: 31818765 DOI: 10.1016/j.jad.2019.11.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/19/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND A psychiatric diagnosis involves the physician's ability to create an empathic interaction with the patient in order to accurately extract semiology (i.e., clinical manifestations). Virtual patients (VPs) can be used to train these skills but need to be evaluated in terms of accuracy, and to be perceived positively by users. METHODS We recruited 35 medical students who interacted in a 35-min psychiatric interview with a VP simulating major depressive disorders. Semiology extraction, verbal and non-verbal empathy were measured objectively during the interaction. The students were then debriefed to collect their experience with the VP. RESULTS The VP was able to simulate the conduction of a psychiatric interview realistically, and was effective to discriminate students depending on their psychiatric knowledge. Results suggest that students managed to keep an emotional distance during the interview and show the added value of emotion recognition software to measure empathy in psychiatry training. Students provided positive feedback regarding pedagogic usefulness, realism and enjoyment in the interaction. LIMITATIONS Our sample was relatively small. As a first prototype, the measures taken by the VP would need improvement (subtler empathic questions, levels of difficulty). The face-tracking technique might induce errors in detecting non-verbal empathy. CONCLUSION This study is the first to simulate a realistic psychiatric interview and to measure both skills needed by future psychiatrists: semiology extraction and empathic communication. Results provide evidence that VPs are acceptable by medical students, and highlight their relevance to complement existing training and evaluation tools in the field of affective disorders.
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Affiliation(s)
- Lucile Dupuy
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France.
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Hélène Cassoudesalle
- University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Orlane Ballot
- University of Laval, Centre d'étude des troubles du sommeil, Québec, G1V 0A6, Canada
| | - Patrick Dehail
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Bruno Aouizerate
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Emmanuel Cuny
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Etienne de Sevin
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France
| | - Pierre Philip
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
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13
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Fonzi L, Picardi A, Monaco V, Buonarroti M, Prevete E, Biondi M, Pallagrosi M. Clinician's Subjective Experience in the Cross-Cultural Psychiatric Encounter. Psychopathology 2020; 53:282-290. [PMID: 32882691 DOI: 10.1159/000509489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Laura Fonzi
- Training Institute, Italian Psychoanalytic Society, Rome, Italy,
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Valentina Monaco
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Buonarroti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Elisabeth Prevete
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mauro Pallagrosi
- Department of Human Neurosciences, Policlinico Umberto I Hospital, Rome, Italy
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Gozé T, Fazakas I. Imagination and Self Disorders in Schizophrenia: A Review. Psychopathology 2020; 53:264-273. [PMID: 33059352 DOI: 10.1159/000509488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022]
Abstract
Anomalies of imagination are frequent and handicapping in schizophrenia spectrum disorders (SSDs) but neglected in psychopathology due to the lack of a conceptual framework to model disorders of imagination. Recently, the link between minimal self disorders and pathology of imagination has been emphasized. The aim of the present article is to discuss this initiative by stressing their paradigm drawing on the recent imaginary turn in phenomenological research. Although this field of research is currently very active in philosophy, there are very few translational approaches in psychopathology or cognitive sciences. In this paper, we examine how contemporary research concerning fantasy and imagination can lead to the elaboration of an epistemological and phenomenological framework for schizophrenia research. We first examine the psychopathological literature on anomalous fantasy and imagination in SSDs. Then we propose an exhaustive overview of the imaginary turn of philosophical phenomenology. Further, we examine the theoretical and practical implications of such a recasting of phenomenological research. We show how fantasy and imagination are involved in the embodiment process, and how identity and imagination are interlinked. Finally, we propose an overview of the possible implications for the understanding of psychotherapeutic processes and recovery strategies.
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Affiliation(s)
- Tudi Gozé
- Service de Psychiatrie, Psychothérapies et Art-Thérapie, CHU de Toulouse, Toulouse, France, .,Equipe de Recherche sur les Rationalités Philosophiques et les Savoirs, Université Toulouse Jean Jaurès, Toulouse, France, .,Institut für Transzendentalphilosophie und Phänomenologie, Wuppertal University, Wuppertal, Germany,
| | - Istvan Fazakas
- Institut für Transzendentalphilosophie und Phänomenologie, Wuppertal University, Wuppertal, Germany
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