Psychopatology

The analysis of mental disorders necessarily requires careful and multilayered reflection. Psychiatry is indeed focused on complex phenomena and symptoms that can be only partly traced back to merely quantitative objectifiable data. This is the reason why we witness a growing methodological and conceptual “mutual enlightenment” between philosophy and psychiatry. Whereas philosophy offers notions that can help to take into account also the qualitative aspects and the lived experiences of pathologies, clinical psychiatry seems to represent one of the most relevant practical fields for philosophy to test its explanatory capacity in relation to its many important issues. The history of phenomenological psychopathology, in particular, shows that philosophers have demonstrated a keen interest in the practical consequences of these issues in the field of clinical psychopathology.

It is important to note that, in diagnosing and analyzing some disorders as well as in providing therapeutic instructions, psychiatry turns to concepts that have a pronounced philosophical relevance. Human being, person, self, intersubjectivity, common sense, lived body (Leib) and inanimate body (Körper) are but some of the concepts employed to comprehend several psychopathologies – for instance, those entailing profound emotional and intersubjective disabilities such as schizophrenia, autism spectrum disorder and depression. These notions have been the object of lively philosophical discussions. It is therefore quite difficult to imagine, for example, that the connections between time, body and otherness which emerge in certain psychopathologies could be analyzed in complete detachment from the philosophical debate over these issues or without asking whether there is any relationship between mental disorders and the peculiarity of human existence.

Considering these convergences, this special issue offers to its readers a series of contributions that investigate the possible relationships between specific psychopathological symptoms and some crucial philosophical issues from various viewpoints. Joel Krueger and Michelle Maiese argue that the notion of “mental institutions” – discussed in recent debates about extended cognition – can help better understand the origin and character of social impairments in autism, and also help illuminate the extent to which some mechanisms of autistic dysfunction extend across both internal and external factors (i.e., they do not just reside within an individual’s head). In his two papers, John Cutting explores the modus vivendi of schizophrenia and that of depression in relation to Max Scheler's phenomenology. Guido Cusinato develops a critical reflection on Cutting’s proposal, highlighting the intersubjective and enactive dimension of valueception impairments. Underlying  this discussion between Cutting and Cusinato there is a different way of interpreting the relationship between the modus vivendi of schizophrenia and Scheler’s phenomenological reduction. The next issue of the journal will include Cutting’s response to Cusinato’s observations. Guilherme Messas and Melissa Tamelini analyze two concepts of a philosophical origin – that of dialectics and that of essence – which, in their strict application to psychopathology, could be of considerable value for diagnostic purposes and for the introduction and follow-up of therapeutic strategies. Lucas Bloc and Virginia Moirera propose an outline of clinical phenomenology for eating disorders inspired by Merleau-Ponty’s philosophical phenomenology. Francesca Brencio explores the “pathic” dimension of existence, which is the capacity of both being affected and being situated within moods and atmospheres. The broader purpose of her paper is to show how the “pathic” dimension of existence is related to psychopathology and clinical practice, for example in affective disorders and schizophrenia. Valeria Bizzari draws attention to the interaffective and intersubjective dimensions of Asperger’s subjects. Finally, Gilberto di Petta and Mario Rossi Monti highlight the importance of the debate on these issues that took place in Italy, retracing the history of the Italian Society for Phenomenological Psychopathology and the School of Phenomenological-Dynamic Psychotherapy.

There will be a further issue of the journal on this topic. All together, these papers aim to promote a closer comparison and collaboration between psychiatry and philosophy, going beyond a reductive and merely symptomatological conception of mental illness and widening the horizon so as to research areas that so far have remained on the margins of phenomenological psychopathology, such as the dimensions concerning value and affectivity.


John Cutting and Guido Cusinato

The debate about the validity of the Rorschach test, compared with psychometric inventories, is particularly relevant in the forensic evaluation. The aim of the study is to present an overview on the control indices proposed in Rorschach (e.g. R, F%, Lambda Index) and in a personality inventory (Personality Assessment Inventory: e.g., openness, desirability, inconsistency, infrequency, negative and positive impression, malingering and defensiveness, treatment rejection) and to cross-correlate these indices.

The concept of beauty in Gestalt therapy is explored, underlining the central importance of the aesthetic criterion for this model. Aesthetic evaluation, which is an essential component in the work of any Gestalt therapist, is a prereflexive and preverbal process, located at the root of the Gestaltung, in the dimension in which the subect and the world emerge. An original conception of psychopathology and psychotherapy is discussed: psychopathological suffering is conceived as an absence at the contact boundary. Therapy therefore consists in restoring presence to the encounter, through a process which transforms absence into pain and pain into beauty. The therapeutic engagement in 'distilling beauty' from the relational histories and dynamics narrated by the client is considered from an existential perspective, seeking to make sense of human suffering and of our work as therapists. Finally, in this light, we consider the ethical ground of psychotherapy, which permits us to a...

El presente trabajo se propone investigar la producción de la categoría clínica de "histeria", y la producción del cuerpo histérico, en el marco de las experiencias clínicas de la Salpê-trière. Intentaremos demostrar que el descubrimiento de la histeria como categoría patológica hacia fin de siglo XIX, tiene como condición de posibilidad la producción de un cuerpo histérico que no sólo será principalmente femenino, sino que además tendrá una serie de valores androcéntricos. Para ello recurriremos, principalmente, a la noción de la producción performativa de Judith Butler.

From 1965, the Swedish penal law does not require accountability as a condition for criminal responsibility. Instead, severely mentally disordered offenders are sentenced to forensic psychiatric care. The process that led to the present legislation had its origins in a critique of the concept of accountability that was fi rst launched 50 years earlier by the founding father of Swedish forensic psychiatry, Olof Kinberg. The concept severe mental disorder is part of the Criminal Code as well as the Compulsory Mental Act. The medical conditions for being sentenced to forensic psychiatric care are supposed to be the same as those for being admitted to involuntary psychiatric care. What these conditions are is not regulated in any law. For the guidance of the courts and others, there is a collection of examples in the government bill drafting the legislation in question. On the basis of these examples the content of the concept of severe mental disorder is chiselled out. However, the purposes of imposing penal law sanction and admitting someone to psychiatric care are not the same, and therefore the content of the concept severe mental disorder is bound to differ accordingly. Severe mental disorder is a legal concept that masks as a psychiatric one. In its applications in penal law, the court determines its content. But for the forensic psychiatrist it is more natural to interpret the term as a medical one. This creates a tension that has led to several controversies in recent criminal cases in Sweden. The best way to alleviate the situation is to discard the concept of severe mental disorder from criminal law. This will allow for a better separation of the roles of the psychiatrist and the court.

Schizophrenia has been described as a self-disorder, whereas social deficits are key features of the illness. Changes in " resting state " activity of brain networks involved in self-related processing have been consistently reported in schizophrenia, but their meaning for social perception deficits remains poorly understood. Here, we applied a novel approach investigating the relationship between task-evoked neural activity during social perception and functional organization of self-related brain networks during a " resting state ". " Resting state " functional MRI was combined with task-related functional MRI using a social perception experiment. Twenty-one healthy control participants (HC) and 21 outpatients with a diagnosis of schizophrenia (SCH) were included. There were no significant differences concerning age, IQ, education and gender between the groups. Results showed reduced " resting state " functional connectivity between ventromedial prefrontal cortex and dor-sal posterior cingulate cortex in SCH, compared to HC. During social perception, neural activity in dorsal posterior cingulate cortex and behavioral data indicated impaired congruence coding of social stimuli in SCH. Task-evoked activity during social perception in dorsal posterior cingulate cortex co-varied with dorsal posterior cingulate cortex-ventromedial prefrontal cortex functional connectivity during a " resting state " in HC, but not in SCH. Task-evoked activity also correlated with negative symptoms in SCH. These preliminary findings, showing disrupted prediction of social perception measures by " resting state " functioning of self-related brain networks in schizophrenia, provide important insight in the hypothesized link between self and social deficits. They also shed light on the meaning of " resting state " changes for tasks such as social perception.

Three revolutions in psychiatry characterised the closing decade of the twentieth century: 1) in the neurosciences, 2) in patient-centred models of service delivery, and 3) in the emergence of a rapidly expanding new cross-disciplinary field of philosophy and psychiatry. Starting with a case history, the paper illustrates the impact of this third revolution - the new philosophy of psychiatry - on day-to-day clinical practice through training programmes and policy developments in what has become known as values-based practice. Derived from philosophical value theory and phenomenology, values-based practice is a partner to evidence-based practice in supporting clinical decision-making in the highly complex environment of mental health care. The paper concludes by setting values-based practice in context with other potentially practical important areas of the new philosophy of psychiatry arguing that all three revolutions need to be brought together if psychiatry is to meet the challenges of the twenty-first century.

Ci piace considerarci macchine pensanti convinte di avere tutto sotto controllo, che analizzano problemi, soppesano vantaggi e svantaggi prima di scegliere la soluzione migliore. Ma siamo proprio sicuri di sapere perché facciamo le cose che facciamo, scegliamo le cose che scegliamo?
Comprendere origini e ragioni di questa attività della mente è la sfida di un libro che intraprende un viaggio lungo l’arcipelago di isole, dai bordi frastagliati e mutevoli, che chiamiamo azione umana. La decisione è un processo della vita psichica in cui intervengono razionalità, intuito, fattori biologici, norme culturali, desideri inconsapevoli. Emerge nell’incognito, da processi che sfidano il pensiero.
Quando decidiamo ci esorta a indagare da una prospettiva inconsueta, ci conduce sul versante in ombra della conoscenza, propone un’idea di razionalità limitata: prendere una decisione è soltanto per metà un processo consapevole, perché nel “sistema aperto” che è il nostro cervello gioca la sua parte anche la sovranità invisibile dell’inconscio.

From 1965, the Swedish penal law does not require accountability as a condition for criminal responsibility. Instead, severely mentally disordered offenders are sentenced to forensic psychiatric care. The process that led to the present legislation had its origins in a critique of the concept of accountability that was fi rst launched 50 years earlier by the founding father of Swedish forensic psychiatry, Olof Kinberg. The concept severe mental disorder is part of the Criminal Code as well as the Compulsory Mental Act. The medical conditions for being sentenced to forensic psychiatric care are supposed to be the same as those for being admitted to involuntary psychiatric care. What these conditions are is not regulated in any law. For the guidance of the courts and others, there is a collection of examples in the government bill drafting the legislation in question. On the basis of these examples the content of the concept of severe mental disorder is chiselled out. However, the pur...

Se la follia è la negazione della ragione e la ragione è il luogo del linguaggio, la malattia mentale dovrebbe allora colpire alla radice la competenza linguistica dei soggetti psicotici. Come mai, allora, gli schizofrenici non solo sono capaci di prestazioni lessicali e sintattiche sorprendenti, ma riescono addirittura a costruire ex novo lingue intere perfettamente regolari' Perché i paranoici, all'interno della loro lucidità delirante, riescono a fabbricare argomentazioni e simulazioni formalmente inconfutabili' Questo volume intende rispondere a tali interrogativi. Raffrontando sistematicamente, in una prospettiva storica, teorica ed empirica, il discorso psicotico con le strutture linguistiche delle patologie cerebrali - afasia, agnosia, autismo - o con quelle esibite dai soggetti normali, si dimostra come la follia conduca a un drastico impoverimento della complessità dei significati: la semantica schizofrenica, anche se realizzata in forme superficiali corrette, è sempre un universo incomunicabile del tutto "privato"; il discorso paranoico è un virtuosistico dispiegarsi di un unico contenuto delirante che eternamente ritorna. La filosofia della mente psicotica appare, così, paradossalmente, un modello vivente di quello stesso riduzionismo con cui le scienze cognitive cercano di spiegare il pensiero intelligente. Nel corso delle tre parti in cui si articola, il libro mette a disposizione degli studi universitari non solo il confronto fra le diverse filosofie della mente con cui si è interpretato il linguaggio psicotico, ma soprattutto l'analisi di testi originali - lettere, biografie, trattati, poesie - conservati negli archivi di alcuni ex manicomi, o appositamente registrati in interviste tra medici e pazienti: un materiale affascinante e ricco d'interesse per linguisti, filosofi, semiotici, psicologi e operatori clinici.