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Daub J, Brandt GA, Volkmer S, Northoff G, Hirjak D. Arthur Schopenhauer: An underappreciated philosopher in psychiatry and his applied epistemology of body and self- experience. Schizophr Res 2024; 267:487-496. [PMID: 38693031 DOI: 10.1016/j.schres.2024.04.019] [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: 01/30/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Arthur Schopenhauer (1788-1860) was one of the most important thinkers of the 19th century. Although his writings have exerted great influence in many different disciplines, his epistemological concepts and analysis of the body and self-experience were rarely considered in the context of psychiatric research of schizophrenia spectrum disorders (SSD) and depression (MDD). METHODS The method applied for the study of anomalous self and body-experience first consists in the close reading and analysis of Schopenhauer's most influential writings, namely his opus magnus "The World as Will and Representation" and his dissertation "On the Fourfold Root of the Principle of Sufficient Reason". Second, psychopathological and phenomenological aspects of the anomalous body and self, as well as altered space and time experience, are discussed by means of Schopenhauer's philosophy and four patient cases. RESULTS Schopenhauer's insights contribute to contemporary psychiatry by (1) unifying materialistic (neurobiological) and idealistic (subjective) conceptions of psychiatric disorders and improving the awareness of methods in psychiatric research; (2) emphasizing the integral significance of the body as a gateway to the surrounding world and basal self-experience; (3) delineating subjective space and time-experience as crucial dimensions of the conditio humana in SSD and MDD; and (4) demonstrating the feasibility of transferring his theories directly to clinical case vignettes stemming from the daily clinical routine. CONCLUSION Close reading of Schopenhauer's texts might help bridge the gap between different scientific methods in psychiatry and overcome the translational crisis of contemporary psychiatry by unifying neurobiological and subjective approaches to SSD and MDD.
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Affiliation(s)
- Jonas Daub
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; German Centre for Mental Health (DZPG), partner site Mannheim, Germany.
| | - Geva A Brandt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; German Centre for Mental Health (DZPG), partner site Mannheim, Germany
| | - Sebastian Volkmer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; German Centre for Mental Health (DZPG), partner site Mannheim, Germany
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; German Centre for Mental Health (DZPG), partner site Mannheim, Germany.
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Northoff G, Hirjak D. Spatiotemporal Psychopathology - An integrated brain-mind approach and catatonia. Schizophr Res 2024; 263:151-159. [PMID: 36335076 DOI: 10.1016/j.schres.2022.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Catatonia is featured by complex symptoms combining motor, affective and behavioral phenomena as well as by its syndrome character with trans-diagnostic occurrence. It paradigmatically shows the limits of current forms of psychopathology like affective and cognitive approaches with respect to both clinical symptoms and brain mechanisms. We therefore suggest Spatiotemporal Psychopathology (STPP) which, as recently introduced, is here developed further following the latest findings in both clinical psychiatry and neuroscience. STPP is characterized by two core features: (i) an experience-based approach that accounts for symptoms primarily in terms of first-person experience of time-space as distinct from third-person observation of specific functions and related behavior; (ii) an integrated brain-mind approach where the brain's neural topography and dynamic, e.g., inner time and space, are shared by the mind's mental topography and dynamic, e.g., time-space experience, as their "common currency". We demonstrate how these two features can well account for both symptom complexity and trans-diagnostic nature of catatonia. In conclusion, catatonia can serve as paradigmatic example for the need to develop a more comprehensive psychopathological approach in psychiatry. This is provided by STPP that allows integrating subjective experience, clinical symptoms and the brain's neural activity in terms of their inner space-time, e.g., topography and dynamic.
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Affiliation(s)
- Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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3
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Zapata-Ospina JP, Jiménez-Benítez M, Fierro M. "I was very sad, but not depressed": phenomenological differences between adjustment disorder and a major depressive episode. Front Psychiatry 2023; 14:1291659. [PMID: 38146279 PMCID: PMC10749326 DOI: 10.3389/fpsyt.2023.1291659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Adjustment disorder (AD) is a diagnosis that must be differentiated from major depressive episode (MDE) because of the therapeutic implications. The aim of this study is to understand the experience of patients who in their lifetime have been diagnosed with AD as well as MDE to establish the characteristics of each disorder. Methods A descriptive phenomenological approach was used with in-depth interviews to four patients and the method proposed by Colaizzi to understand the experiences and reach the description of both disorders. Results Three women and one man, with advanced schooling were interviewed. The participants emphasized the existence of differences that were grouped in: the attribution made by the individual, the theme of cognitions, the variability in the course, the possibility of mood modulation, the syndrome severity, the presence of hopelessness and the perceived course. Conclusion Phenomenological differences were found in the subjective experience of MDE and AD. The MDE would be described as an intense state of generalized shutdown of the subject's own life, with little response to events, and the AD, as a dynamic reaction attributed to a stressful event, with high variability in the course of symptoms due to the dependence on such event, with the preserved hope that it will end.
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Affiliation(s)
- Juan Pablo Zapata-Ospina
- Institute of Medical Research, School of Medicine, Universidad de Antioquia, Academic Group of Clinical Epidemiology (GRAEPIC), Medellín, Colombia
- Hospital Alma Máter de Antioquia, Medellín (Antioquia), Medellín, Colombia
| | - Mercedes Jiménez-Benítez
- Department of Psychology, Faculty of Social and Human Sciences, University of Antioquia, Medellín, Colombia
| | - Marco Fierro
- Department of Psychiatry, School of Medicine, Fundación Universitaria Sanitas, Psychopathology and Society Research Group, Bogotá, Colombia
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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.
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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
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5
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Spencer LJ. Hermeneutical injustice and unworlding in Psychopathology. PHILOSOPHICAL PSYCHOLOGY 2023; 36:1300-1325. [PMID: 38013682 PMCID: PMC10545401 DOI: 10.1080/09515089.2023.2166821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/05/2023] [Indexed: 01/23/2023]
Abstract
The rich literature in phenomenological psychopathology regards the communicative difficulties accompanying psychiatric illness as a product of 'unworlding': the experience of a drastic change in one's habitual field of experience. This paper argues that the relationship between speech expression and unworlding in psychiatric illness is more complex than previously assumed. Not only does unworlding cause a breakdown in speech expression, but a breakdown in speech expression can perpetuate, and even exacerbate, the experience of unworlding characteristic of psychiatric illness. In other words, I identify a two-way relationship between unworlding and the communication breakdown in psychiatric illness. Merleau-Ponty's phenomenology of speech expression is drawn upon to demonstrate how hermeneutical injustice in psychiatric healthcare can elicit unworlding for the person with a psychiatric illness.
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Zurn P, Stramondo J, Reynolds JM, Bassett DS. Expanding Diversity, Equity, and Inclusion to Disability: Opportunities for Biological Psychiatry. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1280-1288. [PMID: 36038045 DOI: 10.1016/j.bpsc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/28/2022] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
Given its subject matter, biological psychiatry is uniquely poised to lead STEM (science, technology, engineering, and mathematics) DEI (diversity, equity, and inclusion) initiatives related to disability. Drawing on literatures in science, philosophy, psychiatry, and disability studies, we outline how that leadership might be undertaken. We first review existing opportunities for the advancement of DEI in biological psychiatry around axes of gender and race. We then explore the expansion of biological psychiatry's DEI efforts to disability, especially along the lines of representation and access, community accountability, first-person testimony, and revised theoretical frameworks for pathology. We close with concrete recommendations for scholarship and practice going forward. By tackling head-on the challenge of disability inclusion, biological psychiatry has the opportunity to be a force of transformation in the biological sciences and beyond.
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Affiliation(s)
- Perry Zurn
- Department of Philosophy and Religion, American University, Washington, DC; Department of Critical Race, Gender and Culture Studies, American University, Washington, DC.
| | - Joseph Stramondo
- Department of Philosophy, San Diego State University, San Diego, California
| | - Joel Michael Reynolds
- Department of Philosophy, Kennedy Institute of Ethics, Georgetown University, Washington, DC; Hastings Center, Garrison, New York; Greenwall Foundation, New York, New York
| | - Dani S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Santa Fe Institute, Santa Fe, New Mexico
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7
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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.
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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
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8
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Rema JP, Novais F, Telles Correia D. A commentary on Effective Connectivity Between the Orbitofrontal Cortex and the Precuneus Differentiates Major Psychiatric Disorders: Results from a Transdiagnostic Spectral DCM Study. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 22:CNSNDDT-EPUB-123591. [PMID: 35578887 DOI: 10.2174/1871527321666220516111544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/06/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
Translational psychiatry has been a hot topic in Neurosciences research. The authors present a commentary on the relevant findings from a transdiagnostic study applicable to clinic practice. Additional discussion on conceptual and clinical insight into this current broad line of research is explored in the integration of multi-level paradigm in Psychiatry research.
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Affiliation(s)
- João Paulo Rema
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte (CHULN), Hospital de Santa Maria, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Filipa Novais
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte (CHULN), Hospital de Santa Maria, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Portugal
- ISAMB - Instituto de Saúde Ambiental, Lisboa, Portugal
| | - Diogo Telles Correia
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte (CHULN), Hospital de Santa Maria, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Portugal
- ISAMB - Instituto de Saúde Ambiental, Lisboa, Portugal
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9
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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.
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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
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10
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Mancini M, Esposito CM. Lived body and the Other's gaze: a phenomenological perspective on feeding and eating disorders. Eat Weight Disord 2021; 26:2523-2529. [PMID: 33544360 PMCID: PMC8602135 DOI: 10.1007/s40519-020-01103-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022] Open
Abstract
According to the phenomenological perspective, the lived body disorder is a core feature of feeding and eating disorders (FEDs). Persons with FEDs experience their own body first of all as an object looked by another person, rather than coenaesthetically or from a first-person perspective. In particular, the main features of this disorder are: alienation from the own body and from the own emotions, disgust for it, shame, and an exaggerated preoccupation for the way in which one appears to the others. Phenomenological research has recently highlighted that the gaze of the Other plays an important role. Because persons with FEDs cannot have an experience of their own body from within or coenesthetically, they need to apprehend their own body from outside through the gaze of the Other. This way of apprehending one's own body when it is looked by another person is called by Sartre the 'lived body-for-others'. Normally, the constitution of one's own body, and consequently of one's own Self and identity depends on the dialectic integration between the first-person apprehension of one's body (lived body) that it is based on coenaesthesia, and the third-person one, that it is based on the sense of sight (lived-body-for-others). When the dialectic is unbalanced toward the pole of the lived-body-for-others, experienced from without, the symptom occurs. Starting from these clinical observations, the so-called Optical-Coenaesthetic Disproportion model has been developed. In this paper, we describe this model, its philosophical and clinical foundations, and finally its clinical implication and its relationship with other disciplines, i.e., neurosciences. Level of evidence: V.
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Affiliation(s)
- Milena Mancini
- Department of Psychological, Humanistic and Territorial Sciences, University "G. D'Annunzio", Via Dei Vestini 31, 66013, Chieti, IT, Italy.
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11
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Messas G. Plea for Using Dialectical Phenomenological Psychopathology as an Approach for Substance-Use Disorders. CLINICAL NEUROPSYCHIATRY 2021; 18:185-187. [PMID: 34909033 PMCID: PMC8650190 DOI: 10.36131/cnfioritieditore20210401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Guilherme Messas
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
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12
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Abstract
There is growing recognition that substance use is associated with the emergence of psychosis.Elements of post-modernity dominate contemporary social contexts and operate as existential background factors that contribute to the emergence of substance-related psychotic phenomena, particularly use of potent and highly rewarding novel psychoactive substances (NPS). About 25% of first-episode psychoses are substance-induced (SIP). DSM-5 SIP diagnosis is based on the assumption that symptoms are transient and disappear after sustained abstinence. This narrowed definition does not consider the issue of persistent SIP. There is a clear need for a new diagnostic framework that provides reliable, unambiguous clinical criteria to differentiate between comorbid conditions (i.e., schizophrenia patients with a substance use disorder) and substance-related psychoses. In the present contribution, we aim to outline a novel and separate clinical entity: substancerelated exogenous psychosis (SREP). Within this diagnostic category, we refer to both transientand persistent psychoses associated with substance use. SREP is conceived as a distinct psychoticdisorder with psychopathological specificities that clearly differentiate it from schizophrenia. We address differences in terms of clinical presentation, epidemiology, etiological models and treatment response. SREP is characterized by altered states of consciousness, persecutory delusions, visual and cenesthetic hallucinations, impulsivity and psychomotor agitation, affectiveand negative symptoms, a pervasive feeling of unreality and intact insight. Delusions are typically secondary to abnormal perception resulting from a characteristic "sensorialization" of the world. Longitudinal studies are warranted to substantiate our hypothesis of a novel diagnostic categoryand support the clinical validity of SREP. This may have important implications in terms of early differential diagnosis and staging (i.e., between comorbid conditions, persistent and transientsubstance-related psychotic states) as well as choice of treatment interventions.
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13
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Stoyanov D, Maes MHJ. How to construct neuroscience-informed psychiatric classification? Towards nomothetic networks psychiatry. World J Psychiatry 2021; 11:1-12. [PMID: 33511042 PMCID: PMC7805251 DOI: 10.5498/wjp.v11.i1.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/15/2020] [Accepted: 12/26/2020] [Indexed: 02/06/2023] Open
Abstract
Psychiatry remains in a permanent state of crisis, which fragmented psychiatry from the field of medicine. The crisis in psychiatry is evidenced by the many different competing approaches to psychiatric illness including psychodynamic, biological, molecular, pan-omics, precision, cognitive and phenomenological psychiatry, folk psychology, mind-brain dualism, descriptive psychopathology, and postpsychiatry. The current "gold standard" Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases taxonomies of mood disorders and schizophrenia are unreliable and preclude to employ a deductive reasoning approach. Therefore, it is not surprising that mood disorders and schizophrenia research was unable to revise the conventional classifications and did not provide more adequate therapeutic approaches. The aim of this paper is to explain the new nomothetic network psychiatry (NNP) approach, which uses machine learning methods to build data-driven causal models of mental illness by assembling risk-resilience, adverse outcome pathways (AOP), cognitome, brainome, staging, symptomatome, and phenomenome latent scores in a causal model. The latter may be trained, tested and validated with Partial Least Squares analysis. This approach not only allows to compute pathway-phenotypes or biosignatures, but also to construct reliable and replicable nomothetic networks, which are, therefore, generalizable as disease models. After integrating the validated feature vectors into a well-fitting nomothetic network, clustering analysis may be applied on the latent variable scores of the R/R, AOP, cognitome, brainome, and phenome latent vectors. This pattern recognition method may expose new (transdiagnostic) classes of patients which if cross-validated in independent samples may constitute new (transdiagnostic) nosological categories.
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Affiliation(s)
- Drozdstoy Stoyanov
- Department of Psychiatry and Medical Psychology, Research Institute, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
| | - Michael HJ Maes
- Department of Psychiatry and Medical Psychology, Research Institute, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
- Department of Psychiatry, Deakin University, Geelong 3220, Australia
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14
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Dolce P, Marocco D, Maldonato MN, Sperandeo R. Toward a Machine Learning Predictive-Oriented Approach to Complement Explanatory Modeling. An Application for Evaluating Psychopathological Traits Based on Affective Neurosciences and Phenomenology. Front Psychol 2020; 11:446. [PMID: 32265781 PMCID: PMC7105860 DOI: 10.3389/fpsyg.2020.00446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/26/2020] [Indexed: 12/11/2022] Open
Abstract
This paper presents a procedure that aims to combine explanatory and predictive modeling for the construction of new psychometric questionnaires based on psychological and neuroscientific theoretical grounding. It presents the methodology and the results of a procedure for items selection that considers both the explanatory power of the theory and the predictive power of modern computational techniques, namely exploratory data analysis for investigating the dimensional structure and artificial neural networks (ANNs) for predicting the psychopathological diagnosis of clinical subjects. Such blending allows deriving theoretical insights on the characteristics of the items selected and their conformity with the theoretical framework of reference. At the same time, it permits the selection of those items that have the most relevance in terms of prediction by therefore considering the relationship of the items with the actual psychopathological diagnosis. Such approach helps to construct a diagnostic tool that both conforms with the theory and with the individual characteristics of the population at hand, by providing insights on the power of the scale in precisely identifying out-of-sample pathological subjects. The proposed procedure is based on a sequence of steps that allows the construction of an ANN capable of predicting the diagnosis of a group of subjects based on their item responses to a questionnaire and subsequently automatically selects the most predictive items by preserving the factorial structure of the scale. Results show that the machine learning procedure selected a set of items that drastically improved the prediction accuracy of the model (167 items reached a prediction accuracy of 88.5%, that is 25.6% of incorrectly classified), compared to the predictions obtained using all the original items (260 items with a prediction accuracy of 74.4%). At the same time, it reduced the redundancy of the items and eliminated those with less consistency.
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Affiliation(s)
- Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Davide Marocco
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Mauro Nelson Maldonato
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Sperandeo
- SiPGI Postgraduate School in Gestalt Integrated Psychotherapy, Torre Annunziata, Italy
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Souza C, Melo AK, Moreira V. The Lived Space of Ana: a Clinical Case Study from the Perspective of Phenomenological Psychopathology. TRENDS IN PSYCHOLOGY 2020. [DOI: 10.9788/s43076-019-00010-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Lajoie C, Fortin J, Racine E. Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness. Account Res 2019; 26:439-459. [PMID: 31599171 DOI: 10.1080/08989621.2019.1679121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept.
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Affiliation(s)
- Corinne Lajoie
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal , Montréal , Québec , Canada
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal , Montréal , Québec , Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal , Montréal , Québec , Canada.,Department of Neurology and Neurosurgery, McGill University , Montréal , Québec , Canada.,Division of Experimental Medicine (Biomedical Ethics Unit), McGill University , Montréal , Québec , Canada.,Department of Medicine and Department of social and preventive medicine (Bioethics programs), University of Montreal , Montréal , Québec , Canada
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Messas GP, Fukuda L, Pienkos E. A Phenomenological Contribution to Substance Misuse Treatment: Principles for Person-Centered Care. Psychopathology 2019; 52:85-93. [PMID: 31382260 DOI: 10.1159/000501509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/13/2019] [Indexed: 01/19/2023]
Abstract
Despite the significant need for coordinated approaches to the treatment of substance misuse worldwide, there are still major gaps in both the provision of services and in the development of a theoretically unified approach to care. We suggest that a phenomenological approach to care can provide comprehensive, theoretically grounded guidelines that coordinate and help choose between a range of interventions while respecting the values of the patient and other stakeholders. The aim of this paper is to present a framework for a person-centered approach to substance misuse care, based on general principles of phenomenology. In particular, we emphasize a dialectic conception of phenomenological care, one that considers the various tensions and conflicts of human life, and the ways these are managed by individuals. Two dialectics are presented here: the dialectic of anthropological proportions, involved in the existential situation of the substance misuser, and the dialect of decision, which is essential to all approaches to the treatment of substance misuse. The dialectic of proportions in the substance misuser's experience involves hyperpresentification, the tendency to emphasize the present moment to the relative exclusion or reduction of the past and future considerations, and feelings of plenitude, an oversimplification of experience that ignores the complexity present in every situation. Interventions should reflect a dialectic of decision, which allows the clinician and patient to choose pathways that promote movement and expand the limitations of hyperpresentification and plenitude. This phenomenological framework, we suggest, permits a collaborative and values-based approach to comprehensive clinical decision-making.
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Affiliation(s)
- Guilherme P Messas
- Department of Psychiatry and Medical Psychology, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil,
| | - Lívia Fukuda
- Brazilian Society for Phenomeno-Structural Psychopathology, São Paulo, Brazil
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Fuchs T, Messas GP, Stanghellini G. More than Just Description: Phenomenology and Psychotherapy. Psychopathology 2019; 52:63-66. [PMID: 31401631 DOI: 10.1159/000502266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany,
| | - Guilherme Peres Messas
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Giovanni Stanghellini
- Department of Psychological, Health and Territorial Sciences, G. d'Annunzio University, Chieti, Italy.,Diego Portales University, Santiago, Chile
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D'Agostino A, Mancini M, Rossi Monti M. Phenomenology in Psychoanalysis: Still an Open Debate? Psychopathology 2019; 52:104-109. [PMID: 31141815 DOI: 10.1159/000500327] [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: 01/16/2019] [Accepted: 04/12/2019] [Indexed: 11/19/2022]
Abstract
In a recent book Cristopher Bollas, one of the greatest contemporary psychoanalysts, tells about how he began to bring together phenomenology and psychoanalysis in the clinical setting at the beginning of his career. Working with psychotic patients, he realized that it was first necessary to "absorb" their view of reality before being able to reflect on the mad scenarios of psychosis. In what world did they live? How did they perceive it? Only by "mirroring" this back to the patients was it possible to offer them the experience of being in front of someone trying to understand their world view. Today, phenomenology has been spreading over psychoanalysis more than one can think it did in the past. The aim of this paper is to review and discuss the most relevant theoretical-clinical areas characterizing contemporary psychoanalysis in which phenomenology can claim a legitimate (or still illegitimate for someone) position. The main areas that will be discussed are: (a) the larger relational system or field in which human experience is continually shaped, i.e., the intersubjective matrix in which we are embedded; (b) the capacity to think about the "what" of the patients' experience, rather than the "why" (especially with the most severely disturbed ones); and (c) the crisis of the primacy of interpretation in the analytical technique. Obviously, this review does not have the ambition to be exhaustive. Rather, it just wants to (re)open the discussion on a still controversial but very current topic.
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Affiliation(s)
| | - Milena Mancini
- Department of Psychological, Humanistic, and Territorial Science, University of Chieti-Pescara, Chieti, Italy
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