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An International Journal in Philosophy, Religion, Politics, and the Arts
ISSN 1932-1066

Volume 16, No.2, Fall 2021

Psychopathology and Understanding

Index and Editor's Introduction

On the Importance of Applying Jaspers' Concept of Understanding in Psychopathology
Alina Marin | Queen's University Kingston, Canada

In times of increasing recognition of mental health challenges along with significant progress in neuroscientific research, applying Karl Jaspers' usage of the concept "understanding" to the field of psychopathology promotes a pivotal tool that allows for a closer examination of biological and interpretative psychiatry. Jaspers has given to this concept a central, flexible, and encompassing position within the science of psychopathology in an effort of upholding the humanity of psychiatric patients.

Keywords: Jaspers, Karl; General Psychopathology; understanding; causality; meaningful connections; phenomenology; behavioral expression; empathy; interpretation.


The Misunderstanding of Understanding (Verstehen): Karl Jaspers, Wilhelm Dilthey, and Psychiatry
S. Nassir Ghaemi | Tufts University School of Medicine and
                              Harvard Medical School

Karl Jaspers borrowed the concept of verstehen from Wilhelm Dilthey, an influence that was first explained by the Basque psychiatrist Luis Martín-Santos in the 1950s. Yet, apart from Martín-Santos' work, their relationship in psychiatry mostly has been ignored. Recent scholarship has revealed that Jaspers did not have full access to Dilthey's unpublished writings, and his usage of Dilthey's concept of Verstehen was somewhat incorrect, which would prove to be misleading in later psychiatric debates on psychopathology, especially the ones to do with delusions and the concept of depression. Verstehen is not a contrast to Erklären, in the sense of being absolute opposites, which is the typical view held regarding Jaspers, but it rather depicts two extremes of a single spectrum of knowledge. In all of its manifestations knowledge involves both causal, objective explanation, and subjective, holistic interpretations. The misunderstanding of the idea of Verstehen impacted debates leading up to the creation of the concept of "major depressive disorder" (MDD) in the DSM-III in 1980. In contrast to the conventional wisdom of biopsychosocial eclecticism, psychiatry can be structured according to a basic distinction between disease and non-disease, derived from a more accurate understanding of the construct of Verstehen.

Keywords: Dilthey, Wilhelm; Jaspers, Karl; Martín-Santos, Luis; verstehen; erklären; meaning; understanding; explanation; causation; Diagnostic and Statistical Manual of Mental Disorders (DSM); psychopathology.


Meeting on a Level Playing Field: Psychotic Realities— Worldviews—Existential Communication
Jann E. Schlimme | Hannover Medical School, Germany

Karl Jaspers' understanding of delusion that has been a milestone for psychiatry since its conception in 1913 continues to be influential even today. From a therapeutic perspective, however, his understanding stands in the way of an appropriate encounter with and understanding of people with delusional convictions. By way of examining Jaspers' concept of worldview, which he clearly distinguishes from delusions, this essay explores whether delusional convictions could not be understood as being worldviews after all. This approach can be substantiated and is therapeutically more valuable, when worldviews are understood only as the explicitly narratable part of the patterns of thought and evaluation of the much more comprehensive and essentially pre-reflective patterns of feeling, evaluation, and habitual thought and action of the respective person.

Keywords: Jaspers, Karl; psychosis; delusion; incorrigibility; worldview; habituality; trauma; psychotherapy.


My Way to Lost in Dialogue and Beyond
Giovanni Stanghellini | University of Florence, Italy

This essay outlines my path to Lost in Dialogue, a book in which I tried to consistently answer three questions: what is a human being, what is a psychopathological symptom, and what is a care. My purpose in writing this essay was to ground the practice of the clinic of mental pathology on a solid anthropological basis with a phenomenological matrix. In Anthropology of Vulnerability the continually attained, de-centered nature of human beings is described in terms of eccentricity and its consequence for mental pathology and human freedom. In Disembodied Spirits and Deanimated Bodies, drawing on Aristotle, I explored the fleshiness of human existence and the importance of common sense for experiencing oneself as a cohesive, unitary, embodied self that is separated from its environment yet connected and affectively attuned to it. Thereby I concentrated on the de-realization, de-personalization, and de-socialization that schizophrenic persons undergo that throws them into crisis regarding self-other inter-corporeal attunement and resonance. In Lost in Dialogue, I elaborate psychotherapeutic methods of treatment of mental conditions involving dialoguing with otherness within and without oneself.

The author presents a version of this paper at YouTube.

Keywords: Aristotle; dialogue; schizophrenia; conditio humana; vulnerability; eccentricity; common sense; embodied self; social self; otherness; depersonalization.


Dialoguing with Giovanni Stanghellini's Ideas about Melancholic, Borderline, and Schizoid Personalities
Otto Doerr-Zegers | University of Chile and Diego Portales University,
                              Santiago, Chile

Doerr-Zegers focuses his commentary on three chapters: "Depression and the Idealization of Common Sense Desire," "Borderline Existence and the Glorification of the Thrilled Flesh," and "Schizophrenia and the Disembodiment of Desire." Regarding the first chapter and contrary to Stanghellini, this author doubts that people prone to depression are incapable of love, for reasons that are developed in this essay. Regarding the second chapter, Doerr-Zegers recognizes the important contribution Stanghellini makes to the understanding of borderline personality. However, this author thinks that Stanghellini's description of borderline personality does not defer too much from Jaspers' description of hysteric personality. Given this similarity, it is important to underline the traits that allow distinguishing one personality from the other. Doerr-Zegers thinks that the difference lies in the construction of identity, that is more consistent in hysteric than in borderline personality. Regarding the third chapter where Stanghellini suggests that dis-incarnation and dis-attunement that characterize schizophrenic existence makes the Other somehow unreachable, Doerr-Zegers argues in agreement with Eugen Bleuler—the creator of the concept of schizophrenia—that affectivity is not extinguished in schizophrenic patients, but merely hidden. Psychotherapeutic experiences with such patients have provided ample evidence for this fact.

The author presents a version of this paper at YouTube.

Keywords: Stanghellini, Giovanni; melancholic depression; borderline personality; schizophrenia; common sense; corporeality; interpersonality; psychotherapy in schizophrenia.


In Between Two Realms of Phenomenological Psychopathology—The Open Perspectivism of Giovanni Stanghellini
Guilherme Peres Messas | Santa Casa de São Paulo School of Medical
                                        Sciences, Brazil

In this essay, I explore Giovanni Stanghellini's book Lost in Dialogue as being shaped by a methodological open perspectivism. This is characterized by the refusal of a formation of a closed psychopathological system. I elaborate how Stanghellini makes his thought revolve around two perspectives of phenomenological psychopathology. The first one privileges an examination regarding the language of first-person descriptions of subjective experiences; this perspective is directly linked to Karl Jaspers' approach. The second one develops a hermeneutical analysis of the fundamental structures of altered experiences. I conclude by indicating some clinical-psychopathological issues raised by adhering to this perspective.

The author presents a version of this paper at YouTube.

Keywords: Stanghellini, Giovanni; person-centered approach; psychiatric care; phenomenological psychopathology; descriptive psychopathology; hermeneutical psychopathology; narrativity; conditions of possibility; phenomenological method.


Autonomy, Agency, and Schizophrenia: Reflections on Selfhood and Alterity
Louis A. Sass | Rutgers University

It is commonly observed that schizophrenia is characterized by diminished capacity for autonomy or self-control, by loss of the sense of being the agent of one's actions or even the possessor of one's own experiences. This feature is emphasized in both Giovanni Stanghellini's book Lost in Dialogue and David Shapiro's book Dynamics of Character. Here I consider some ways in which schizophrenia—an eminently paradoxical condition—can also involve forms of exaggerated autonomy. I argue that schizophrenia is best conceived as involving a diminishment of the normal equilibrium between agency and passivity, between independence and dependence on what lies beyond one's self.

The author presents a version of this paper at YouTube.

Keywords: Stanghellini, Giovanni; Shapiro, David; schizophrenia; alterity; selfhood; otherness; ipseity; agency; volition; autonomy.


From the General to the Particular: On the Challenges of Integrating Phenomenology, Hermeneutics, and Psychodynamic Theory
Anthony Vincent Fernandez | University of Southern Denmark, Odense,

In this review, I consider what is distinctive about Giovanni Stanghellini's work, especially as exemplified in his book Lost in Dialogue: Anthropology, Psychopathology, and Care. I show how his enduring concern with the psychotherapeutic encounter sets his work apart from much of the contemporary field of phenomenological psychopathology—motivating a focus on how persons individually cope with mental distress, rather than how they fit into more general diagnostic categories. I argue, moreover, that this person-centered focus generates ambiguities regarding the aims and the subject matter of Stanghellini's work that have yet to be resolved.

The author presents a version of this paper at YouTube.

Keywords: Stanghellini, Giovanni; phenomenological psychopathology; hermeneutics; psychodynamic theory; narrative; values; schizophrenia; depression.



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