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    11 views7 pages

    Lanteri Laura Foundations of Psychiatry

    Uploaded by

    Francisco Mujica Coopman

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    0 Ww, mtasnennuna ys, D. (1073), “Becang od Gel.” Vanek an Rupr ‘Wyss, D. (197). Dic amropologictexsemislonloguche Pacha ‘und She Auswirangentnbesonre auf de Poche und Py. ‘onherapie. fn "Peyholgie des 20: Juanes." Vol I, p- 40-05 (QU Bamer ef). Kinder Zari, ‘enaen, De V. (iv). Korperba, Pychose und Peril. Ner- ema 3, 52-90. 4 Phenomenology and a critique of the foundations of psychiatry G. LANTERI-LAURA, “This chapter isan attempt, concentrating particularly on works in French, to focus attention on the prablems raised by phenomend. logical ‘peychiatry ‘or, put another'way, by the phenomenological Me in psychiatry” This has been done by us and others in French in several publications (Gee, for example, Lanteri-Laura, 1963). Hopefully, this wil show some degree of rigour and concern forthe ‘ambiguities ofthe adjective phenomenologieal. Iti not intended to k what phenomenological paychiatry ought to mean, ast would be Ahieal wo grasp how any obligation to use the words could arse. On the contrary, the question the degree to which a ead adoption of 1 phenomenological approach would, in « Kantian way, alec the foundations of peyehiatic knowledge "To avoid disputes, though, about the exclusively correct way of using the word (phénoménologique, i 6 expedient to briefly con Ser our voeabulay and semantics. The noun phenomenology seems to have been coined by JH, Lambert (176) to mean “the study of tppearances" (Lehre von dem Schein), and fr considerable period the word implied jus that erlerred to an empirical description of human experience. To some extent i ill docs tn all iin lagu ses. ge (1806) revived the term but meant by it a study of the man- rer im which experience manifest tal. The description guided by this mansestation svas to revel the dialectic self. The det did hot produce experience (consciousness), but i i only in eonscios st 2 . kaNTERE-LAtRA experience that it becomes apparent. For long time “phen, fomenalogy” remained a term from the Hegelian tradition, and ‘was Ged fo the dogmas vehi typed the Tess able commentator ‘tudes, (One can see this in France in the works of Hyppalite, (1946) and also in those of Kojeve (1953) and Hamelin (1925) ‘Much later, Hustrl (1913), the mathematician tho became philowpher in order to clarify the basie ideas behind mathematce, {ook up the word himsel. He gave it the meaning which, fellowing him, i has never cezed to have TT now implied not resi to studying man's interior world but a systematic description by 1 reduction tothe transcendental and by an dec reduction. Tn the transcendental reduction, the {uestion of the existence of the world ie put on one ade (entre Darenthise™ = bracketed). "This i the “acgative sept” (the lic {ation or disadvantage). Iti important though, above al, beause ‘in doing so the way in which the neomatic (acrmtic fromm Huse ff and refer to the objective aspect of consciousness Tet and Wiewed after bracketing the question of the existence of the teal ‘word) structure becomes apparent. This is the postive sepect oe Advantage of the sowed tanscendental ‘reduction. The Sleseription is no longer concerned with the object which appears, tbat with the manner in which it appear. The neomaie describe neither interested in the tree nor inthe number, but in the manner by which the mumber or the tree ean become fevealed (perceived, imagined, remembered, ete. Consequenty, all experience can become the object of » neomtic descnption rendered possible by the transcendental reduction. But thi procedure of neomatic ‘scriptions can only be meaningfl if we here employ the eidetic ‘eclueton, that i to sa if we have an adequate appreciation of the function of the example. Troubetzo's (1949) notion (lingustie cer tainty) of commutation is sentially the core type af concept here, “yserl (1913) was followed by Heidegger (1927), and with him came the ideas of existence of temporality, of eing-towarde death (Give fou-lasmort; sen-sum-Tode) an of authentic, a wll a8 the work of Scheler (1919) and Hartmann (1921) in Germany rm this German setting of phenomenology within philosophy two attudes ean be retained, as Mereau-Ponty (1945) stated very accu. {ately in is book, which did wo much co distoue the meaning of plo: “aphicel phenomtenalogy in France. Phesomenigy ie de study of eteces an ll problems accordingly ‘ime back othe dfn of eaenes, for example the esc of 4. muewoueno.ooy axp 4 carnQue OF ventura 53 teption, the enence of consciounes. But phenomenology is also & fluleopy which places ncn back exten and docs ot Geese {hat one can understand a id the Word othe han vpon the Bai of ther “lacy” I ea tancendenal paso hich leven afi Imation ofthe natal attide unreal order to understand hem, Tess ala philosophy for which the word il efor thought ean alee presence and i which the gal af ‘ery ltt to redncver th nae conact withthe weld and give ah lwphieal tus This the at ofa pilouaphy whichis "ene cence" Du i alin a coun of ved space ane and ot he won 1 avery concrete description, onthe one hand perhaps close to ‘empiricism, but on the other hand itis pure evidence of esence. Tn France, phenomenological psychiatry maintains both these aspects. Tos cerain extent the term phenomenology i sed with the ineaning that Jaspers (1910, 1913) gave a hat dexcrption, very precise but a8 hile classified as ponible, of what the patent fel Flowever,atempts have been made to make use of the operational ‘concepts ‘of lived space and time, of the intentionality of conse- foumets, finite, being-in-the-world ('tre-an-monde) and being. towards-death (Féte-pouclasmor) (Saree, 1986, 1960) which require explanation Phenomencogicel_peychitry ie wnquestionably committed to attempting to recapture tuthentially the experience of the patients ‘Minkowsks (1935, 1936, 1948, 1953, 1966), orientating his research, ‘rites that: "What i now important for us, taking che phenomeno! Toga pont of view ete tendency to throw int rele & method for the scully of paychopathological phenomena" At the end of obser ‘ations ofa depressive delusion, he specially states: ea of dlnon woul in thi wey nt be uriguely the product of 3 ‘mov mgm o of problems of jgemen On te cota, thy wold pars t att aa nto tee char {Sols ngnge he inl (longa pyc) he nasa ‘toni wich the dmeprating personaly etal. However SECT ot pen ay be, ce Sin few oad a ting sc ad naar esto heads hse which he Ely manna Tepe tes even hint Dy se SEC he bonows rom hier expr (fino 193) In other word, the patens expressions of elings are dred by the iadoquaey of the onary verbal means te fete «radi Steraton of ved experience, It ti akeration which phenomena loay proposes to resting st uavrenttavna “This corresponds moreover with the idea of basic causes (roubles sénévateurs) “The mental syndrome efor eno longer simple auction of yp set pein of ad hrc maton tthe erie human personaly. The quetion now becomes to stay these diverse modiSeaions, ca which hae hed begun (ia Kwai, 1953) We could multiply the examples with other references to the work ‘of Minkowski, borrowing sz fom work by Ey (1954, 1973), Leguen (41958) Tatosdian (1979) and others Despite some notable individual torginaliy, x certain numberof common points emerge which permit, {sto fel Content with the generality ofthe few examples that we have weed, ‘One initial observation (Bourdieu, 1972) draws our attention toa comparison of the expressed intentions of authors ith their works ‘hemelver: that is totay not so meh the modu operand with the ‘opus operation, a8 the inital statements of procedure with the re starch actully accomplished. Proceeding in this manner, we se Clearly that the attitude thus called phenomenological in peychiatry does come back to attempting to authentically represent the lived texperenee of the patients, even when it explicitly denies doing so. It Infor this same act moreover that socalled cael peychiaty afen finds asf accused (in terme whieh owe more to Bergson than to Host) of carieturing ved experience snd of typlyng the patients inva ried way. We must therefore ak ourselves what 1 really ‘Phenomenological in thi proces which ime at grasping the pu {Experience (Erlebnis) ofthe patient i al its specifiy. "his must be ‘our fest enquiry ‘Phenomenological description is most certainly an attempt to be concrete. Only in the distant past di! philosophy remember to be ‘conerete, However, this regard for the coneretes 4 regurd for ex Smiles, and examples are only of intrest through the eidetie rede: tion. Now, if the payehiatic proces which we have just loated also seus to he entirely conerete, it wll end by using iatropathy for the ‘eomatie description, identifying the later proces a 4 sort of ade {uation more or les tymptti wth the interior fe ofthe subject. Ie ‘ust be added thar this method of procedure isin France to be texplsined by the exten to which the French-speaking publi silly Iinew phenomenology through the Cartesian Mediation of Hser (1947) sehich supplied an introspective version of hi views. From ‘them one might be ld to belive tht she bracketing ofthe world 4. muevouEsotocy axp A CRITIQUE OF roreHIATAY 55 corresponded to a return to introspection and tha it was «question of {Keibing not the manner in Which objects appeared (noematic Structures) but «sort of interior activity (oostie) through which the ‘Sonscousness related to that which was not itself, The ambiguities of fhe term “intentionality” contributed morcover in prolonging the mphibology to the estent that one could understand. phenomen- Slog a8 something which presented sacl ars sort of desertion af the intentionaliey of the consciousnem. If, despite the rigorous de- limitations laid down in Sartee's (1940) work, one makes no division ‘ete the reflecting consciousness (conscience omageante) and the iimainary (imaginare), se becomes permissible to interpret pheno- ‘nological asa supposed description created from the interior ile nd the intentionality ofthe patient It remains a process originating in'a contradiction and lacking the specific nature of the work of Huss) even if it comes lose to Scheler (1950): the “Eiaiung” (empathy) has nothing to do with noematie description "This ft difculty Teas onto second. To describe the lived ex perience of time ia depression, to elfect the phenomenology of pss- ‘hoses, to define accurately the hallucinory consciousness, one ost not put psychiatric knowledge into brackets But on the contrary fscepe ita» fis and not-queston ite postion. If one considers Bailarge’s (1890)" description of hallucinations refed and one wishes to substitute in is stead phenomenology of hallucinations fe cannot put in brackets the payehiatie Knowledge that concerns them, eeaute once this knowledge i suspended the term balucin tion lowe all ssignable sense and one no longer knows what remains to be described. We are touching here on a fundamental por Phenomenology can only be performed on any aspect of the patho- Tegel consciousness on the condition that one accepts paychiatric Inowledge ae tis. To bracket knowledge concerning hallucinations i to prohib the description of this typeof phenomenon, frit 90 Tanger permiesible to distinguish between what is halluciaion and ‘what isnot. However in order to effect phenomenology of hall ‘Gnations one accepts the relevant Knowledge ts it stand, that is mundane knowledge, uncritical and escaping fom the surpension of judgement, theres 0 longer any question of phenomendiogy but father» dcate empire inthe place of an empiric which i judges to be pramitne. Clinical psychiatry thus finds ie presup pose bya dtcripcion which, by the very fac ofthis presuppositi fan no longer remain in any ay phenomenological. TFurehermore, no eidetic reduction fs brought about hee, and the cecental differences which may appear (manic consciousness, 56 2. Lawrentavna Schizophrenic consciousness, etc.) result ot from the systematic use ‘of the variation and intuition of essences (Huser, 1913) but fom 2 borrowing manifest or diguised from categories not based onthe clanfcation of appearaneca, sine they only retain any sense on con Aiton that they are kept outside the phenomenclogical eduction ‘Nether the body nor lnguage hat rece state ere ts not rely hnown whether i sion ofthe by as a expres xing being o san anatomical object, bt nether cave espe fre modalities of ts appearance ae noc described for themselves Tt lace oth the study of the body's appearance an exiting inthe woe snd ofthe appearance of knowledge ofthe body. Thi double de tency prohibits the elucidation of expesiviy jst as it prohib ‘questions on the role of the body inthe prodction of thse pene fomena, Tei the stme with lnguage: any eft made to describe the lived experince of the patient presupposes this, but although s pre equ thn operation, nee racked nor clare hy the lesrption of tatu _ Mice therfore ith hx lo br noes hat in he works under consideration “the adjective phenomenclgia" designates shove all the attention centred onthe faithful insight into the exper ce undergone by the patients. This the meaning understood by Jaspers (1913) in his Gameral Paychopathalgy butt remain » long ‘vay from the steps taken by Huser, "i 4 question, therefore, of subaituing in the place of the necatc deripion at understanding of the pent itor ‘xstence, But this ambiguity appear tus to give rae to two con. fusions with which we must now ea * Tt should fist be noted tht if phenomenology reverts to what the clinician is ttempuing to grasp of the Intenor experience of the Batient, one risk confusing this tempt with» semitigial process Semioligy always const locating certain numberof signs and then discucing their daguontie import. Now, the works whith serve se slerenc for uv endo denounce dh tee wail nd Feted and to view this effort at ntrospecton asthe ppearance ofthe ‘morbid process, The fight of ess for example, soem as being ftrely manic beinginche-world. ‘The search for sign (light of toni excitation, peyconotor, ct, is thus replaced By the fnwuitive grasping of one singe clement which sno longer one ofthe Posie sign ofthe mania bu the manifestation ofthe mane process Sal, sign and proces atthe sate time. This, therefore, the lnk of alifetetiaton between semiology and psychopathology, two areas in which thas by no means been proved thatthe second inst abuord 4. mievomNovocy ano 4 cnrriQue oF estemarn® ST the frst, Semiology consists, furthermore in locating signs and notin ‘lzing the totality ofthe patents lived experience, The sarc Tor sigos i radially ferent from the clinicians identification with feqatd to te interior existence of hi patient: In this respect, this process, which passes for phenomenological, confuses the esctial itintion between semiotogy and paychopatlagy ‘also iavolves an ambiguity in the ate of therapeutic, a con- {ation that Laing and Cooper (1964) have done more than’ anyone alee to uncover. The treatment lacking furthermore acca defined Status ith regard to the body and knowledge, rest in being feduced to “undersanding” in Jasper interpretation af the word Just asthe separation of senioogy and psychopathology is eventually athued for the excive prot of pychopathoogy, thnks to 2 polemic which discredits seminlogy in denouncing its coneete and {eilied character, the stinction between therapeutics i nally once fznin denied forthe benefit of peychopathology. The desired ade {guacy of the totality ofthe lived experience of the patent, a8 is {dicated by the lack of distinction between prychopatblogy and femiaogy, this again found inthe other lack of dtincion which biues the differences between psychopathology and tretment. Tn both casey, tis infact question of leaving to one side everthing that ‘might petty, a0 thatthe authentic night of paychopathlogy Tune tions both as semiotic and as eatment. Thi nthe precise role of xintntial analysis which covers with prestigious but rather facile teferences 2 lack of distinction between ssmpath and ther Behind thse tien evn the ot a orion ad 8 ction t fallback on, it cles thats eetsn polemic in oper: one sen harm i mater, mechani, cate or detail” die Continuity, space, the unconsscusnes andthe Brain, but sees good in the mind (which ia felt to vitaze wheres the formet isl supposed to il) n'a certain dynamism, inthe prevalent concern for toaty| (Cantheit” ints batt ey above the helmet and mato beneath the rest). in the continuum, temporality. consciousness, and im. the “fstaning ofthe body. Inthe sme way it mgested tothe bes of or Dredecenors, Guirad, that this prychstry i 1 i to remain anene Exphalous, should believe without doubt hat only eoton woo! i to be found inthe cranium. "Through this Unk took place withthe romantic philosophy of nature, clearly present in the works of ‘Goldstein (1934) and von Weicker (1948) "Thus we see that phenomenological psychiatry, envisaged as a

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