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Psychopathology in the 21St Century

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Psychopathology in the 21St Century The World Journal of Biological Psychiatry, 2010; 11: 844–851 WFSBP CONSENSUS PAPER Psychopathology in the 21st century MICHAEL MUSALEK1, VERONICA LARACH-WALTERS2, JEAN-PIERRE LÉ PINE3, BRUNO MILLET 4 , WOLFGANG GAEBEL5 ON BEHALF OF THE WFSBP TASK FORCE ON NOSOLOGY AND PSYCHOPATHOLOGY∗ 1 Anton Proksch Institute Vienna, Vienna, Austria, 2 Facultad Ciencias de la Salud, Universidad Andr é s Bello, Escuela de Medicina, Santiago, Chile, 3 Psychiatrie Adultes (CS), H ô pital Fernand Widal, Paris, France, 4 CHU de Rennes, Rennes, France, and 5 Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany Abstract Objectives. The present publication sets out to evaluate the position of psychopathology in the 21st century and should also serve as a basis for defi ning the framework for the future tasks of the WFSBP Task Force. Methods. Review of publications on the various approaches of psychopathology in general and of different tasks, theories and tools of psychopathology approaches in particular. Results. The main tasks of psychopathology are, to record and describe experiential and behavio- ral abnormalities in their intersubjective context, to explain their origin from an objective scientifi c perspective, and to attempt to understand them from the subjective perspective of the patient. In order to provide stable fundaments for the work in clinical and scientifi c psychiatry all three components are indispensable. Conclusions. The future of psychiatry hence lies in the hands of a type of psychopathology that we will call Integrative Psychopathology. The main tasks of psychopa- thology can only be pursued in close cooperation with other branches of science interested in studying psychiatric issues. Whereas contemporary psychopathology must lay the foundations for that cooperation, Integrative Psychopathology must be complemented by further advancements in Theoretical Psychopathology, so as to enable conceptual new developments, which can then be fruitful for cooperative research and psychiatric clinical practice. Key words: Defi nition , psychopathology , tasks , theory , tools Introduction the most part lost one of its most important founda- Any attempt in just a few short pages to provide a tions. Therefore, researchers in the fi elds of biologi- comprehensive account of the diversity of psychopa- cal psychiatry and the neurosciences (which exercised thology, its roots and leaves and its place in 21st such an important infl uence in psychiatry in the last century psychiatry is indeed a daring undertaking. It thirty years) are increasingly redirecting their focus will inevitably result in truncations and can be noth- back to the psychopathological basis of their research ing more than an incomplete outline. Nevertheless, work. we will try to attempt such challenge (would like to Part of the intention behind this, has been to pre- undertake such challenge), all the more so because vent the realisation of a horror vision published more psychopathology as a research area has in recent than 10 years ago by Nancy Andreasen, who wrote decades (unjustly) lost considerable ground or been that if psychiatric research did not again refl ect on its left to other disciplines such as psychology, the social psychopathological roots sciences, and the medical humanities. Due to the fact that researchers in the aforementioned disciplines we high-tech scientists may wake up in 10 years have only loose, if any, contact with researchers in and discover that we face a silent spring. Apply- the fi eld of psychiatry, psychiatric research has for ing technology without the companionship of ∗Task Force Members: Wolfgang Gaebel (Germany); Gordon Parker (Australia); George Papadimitriou (Greece); Jose Luis Ayuso Mateos (Spain); Humberto Casarotti (Uruguay); Marcelo Cetkovich-Bakmas (Argentina); Gisela Gross (Germany); Gerardo M. Heinze (Mexico); Shigenobu Kanba (Japan); Veronica Larach (Chile); Jean-Pierre L é pine (France); Peter McKenna (UK); Bruno Millet (France); Alberto Monchablon (Argentina); Michael Musalek (Austria); Yuji Okazaki (Japan); Hector Perez-Rincon (Mexico); Humberto Rico Diaz (Mexico); Horacio Vargas (Peru); Jan Zbytovsky (Czech Republic). Correspondence: Prof. Dr. M. Musalek, Anton Proksch Institute Vienna, Grä fi n Zichygasse 4 – 6, A-1230 Vienna, Austria. E-mail: [email protected] ISSN 1562-2975 print/ISSN 1814-1412 online © 2010 Informa Healthcare DOI: 10.3109/15622975.2010.510207 Psychopathology in the 21st century 845 wise clinicians with specifi c expertise in PP will direction psychopathology should take in further be a sterile and perhaps fruitless enterprise. developing itself as a science including its method- ological tools, has neither been answered nor asked This danger suggests that it would be wise to once seriously. again attach greater importance to the science and For as soon as we attempt to defi ne the object of art of psychopathology in the training of psychia- our research, we encounter one major diffi culty: in trists. (Andreasen 1998; Hojaij 2000) The increasing psychopathology, i.e. the science of pathological interest in psychopathology that has manifested itself changes of the psyche (soul) there is no actual in recent years is documented not least, by the research object in the traditional sense. The soul, WFSBP ’ s activities in this area. This has resulted in the psyche, is not an object, it is not a thing that the creation of a Task Force on Psychopathology can be examined (Bumke 1948); the soul (psyche), (Chair: W.G.) with the two-fold aim of meeting the the psychological is a state of being which was only need to integrate psychopathological knowledge in made into the supposed object by the process of biological research and creating a platform that per- objectifi cation. mits an interdisciplinary discourse between the neu- rosciences and psychopathology. The present Die Seele ist Bewusstsein … Die Seele ist kein publication therefore not only sets out to evaluate Ding, sondern das Sein in ihrer Welt … Die Seele the position of psychopathology in the 21st century, ist kein endg ü ltiger Zustand, sondern Werden, but should also serve as a basis for defi ning the Entfaltung, Entwicklung … Der Machtbereich framework for the future tasks of the WFSBP Task der Psychopathologie erstreckt sich … auf alles Force. Seelische, das sich in Begriffe konstanter Bedeutung und Mitteilbarkeit fassen l ä sst … “ , [The soul is consciousness.... The soul is not a thing, but Historical roots the Being in its world.... The soul is not a fi nal The beginnings of psychopathology as a comprehen- state, but becoming, growth, development … sively organised and methodologically grounded sci- The sphere of existence of psychology covers ence can be dated to Karl Jaspers ’ seminal work. This all that pertains to the mind that can be does not mean that there had been no earlier attempts conceived in terms of constant meaning and to describe the symptoms and nature of mental ill- communicability] nesses; in this context one should remember the writings of Esquirol (1838), Emminghaus (1878), wrote Karl Jaspers in his General Psychopathology Krafft-Ebing (1879) and St ö rring (1900), to name a (Jaspers 1913/1973). This subsequently led Chris- few. However, as important as they all were in the tian Scharfetter, surely the most distinguished psy- history of psychiatry, none of them can compare to chopathologist of the late 20th century, to remark Karl Jaspers ’ work in terms of completeness and that the object of psychiatry (and thus of course methodological clarity and precision. None of them also its most important foundation, psychopathol- has retained as much practical relevance for almost ogy) in each case, is an entire human being within a century as Jaspers ’ General Psychopathology the context of its development (Scharfetter 1991). (Jaspers 1913/1973). As a logical consequence, he therefore demanded In this work he also defi ned psychopathology as that psychopathology requires both an idiographic- an object of research when he wrote: causal understanding of this development process and nomothetic study. Psychopathology must there- Unser Thema ist der ganze Mensch in seinem fore devote itself fully to the individual human Kranksein, soweit es seelisches und seelisch bedingtes being in his normal-psychological and psycho- Kranksein ist … Unser Thema ist der Mensch … pathological entirety, yet not neglect the nomothetic unser Thema ist die Seele des Menschen … “ [Our approach, i.e. the search for abstract universal subject is the individual as a whole in his illness, principles. Even more: The central task of psycho- inasmuch as it is a mental and psychogenic ill- pathology is to explore the common dimensions ness … our subject is the individual … . our sub- of psychopathological processes building upon ject is the soul of the individual]. the idiographic causal experiences of individual patients. Despite this, to the present day it has remained The fundamental objectives of general psychopa- largely unclear what are the specifi c tasks of psycho- thology can therefore be defi ned in two main cat- pathology and what place psychopathological egories: Firstly to record, to describe and to denote research should hold within the overall structure the subjective experiences and forms of behaviour of psychiatric work and research. Moreover, the and thus present them in a way that allows them 846 M. Musalek et al. to be communicated both intersubjectively and in denen es steht, und die Weisen, wie es sich
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