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 és Bello, Escuela de Medicina, Santiago, Chile, 3 Psychiatrie Adultes (CS), H ôpital 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 behavioral 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 psychopathology 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]

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 methodological 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 neurosciences 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 irgend- interculturally, as tasks of Descriptive Psychopa- wie objektiv ä u ßert, wollen wir untersuchen. “ [We thology or General Psychopathology ( “ Allgemeine want to know what and how human beings expe- Psychopathologie ”) . Secondly, to describe and dis- rience; we want to get to know the entire span of tinguish their existence, nature and development as mental realities. We want to investigate not just a deviation from normal psychological modes of the human experience, but also the conditions existence and experience, as tasks of a “ symptoma- and causes upon which it depends, its relation- tolog y ” or “ Spezielle Psychopathologie” . From the ships and the ways in which it somehow objec- outset, psychopathological research was also tively expresses itself.] (Jaspers 1913/1973) . shaped by a desire to create constructs ( “illnesses ” ) on the basis of the insights of clinical psychopathol- Although modern psychopathological research ogy which works in the frequently blurred and has its main roots in European psychopathology and overlapping area of general and specialised psycho- only later evolved under North American infl uences, pathology and which in the main uses clinical-sta- the results of contemporary research are by no means tistical-descriptive or statistical-analytical methods, restricted to the former. In recent years, in particu- which grouped together in nosographical systems lar, psychopathological knowledge has been signifi - can become the object of aetiology and therapy cantly enriched by work carried out in Africa, Asia research. and South America (Ammar 1970; Kojo 2010; Téllez K. Schneider viewed “ Spezielle Psychopathologie” Carrasco 1985; Okasha 2005; Saravanan et al. 2010). in particular, which he called Clinical Psychopa- In this context, special reference should be made to thology, as a nosologically or nosographically- the seminal work on trans-cultural psychopathology oriented science. It deals with the mentally (Radford 1991; De Figueiredo 1980). abnormal in terms of clinical units and doing so becomes psychopathological symptomatology and diagnostics (Schneider 1946/1980). In his Clinical The spectrum of psychopathology Psychopathology he therefore defi ned disorder Psychopathological research is always caught between catalogues in which different units of mental illness the confl icting poles of the natural given ( “ dona- are constituted, such as fi rst- and second-rank tum ” ) and human constructs ( “ factum ” ). Yet we are symptoms for the diagnosis of schizophrenia. How- all too ready to overlook that each natural given is ever, it should be noted that Schneider himself always something given to us inasmuch as it is only made no nosological claim for his fi ndings (unlike through our perception that it becomes the given Kraepelin in his early writings, but see Kraepelin that we perceive – in other words: our constructs 1920) and therefore never referred to the diagnos- turn each natural given into a mitigated given, for tics of schizophrenia, but instead explicitly pointed us, there is no such thing as a purely natural given. out that in all probability this entity would refer to Conversely, a pure construct is also only possible in several different disorders that present with similar theory; in clinical practice all psychopathological clinical features and which can therefore be cate- constructs (at least to a certain degree) are based on gorised as the group of schizophrenic disorders. what Nature has given us. How closely we position Later, a more differentiated view of psychotic con- ourselves in our pathological research to the pole of ditions incorporating both the nature and narra- the natural given or how far we distance ourselves tives of the disorder was forgotten and Schneider’s from it in order to move toward the fi ctive pole of approach was mixed with Kraepelin’ s classifi ca- pure construct is determined by us and by the par- tions to a “ melange diagnostique ” and the creation ticular form of psychopathology (Figure 1). of the ICD-10 category schizophrenia (Musalek 2003; 2005). In this way a nosographical approach was reduced and distorted to a nosological unit which in turn was then used as the starting point for aetiological or pathogenetic studies. This met a basic need that psychopathology has been expected to fulfi l which Jaspers summarised as follows:

Wir wollen wissen, was und wie Menschen erleben, wir wollen die Spannweite der seelischen Wirklich- keiten kennenlernen. Und nicht nur das Erleben der NATURAL GIVEN HUMAN CONSTRUCT Menschen, sondern auch die Bedingungen und Ursachen, von denen es abh ä ngt, die Beziehungen, Figure 1. See text. Psychopathology in the 21st century 847

Thus all psychopathologies that are based on epoch é , focus is upon the perception, recording, denoting and referring to the suspension of judgment regarding the analysis of the individual psychopathological phenom- true nature of reality (Husserl 1923/1959), such as enon. In the 1980s, Berrios described descriptive classical phenomenological or anthropological psycho- psychopathology as a language-based activity, which – pathology are very close to the natural given, whereas despite its increasingly scientifi c nature – still depends psychoanalytical psychopathology as a predominantly more on the traditions of different psychopathological theory-based form of research is close to the pole of schools and on “psychopathological fashions” than construct. Functional psychopathology as most of scientists and clinicians would like ( Berrios 1984). experimental psychopathological approaches is This also led to the development of diverse “ psycho- located more or less between the two. pathologies ”. Even if today it can be reasonably A further problem with classical psychopathology assumed that this trend has largely ceased, there are is, as Glatzel (1978) correctly criticised, the fact that still those who talk about different psychopathologies, psychopathology is the science of mental abnormal- by which they do not mean the various branches of ities, i.e. the science of abnormal mental states is the science of psychopathology, but the various theo- highly problematic, in as much as it assumes a con- ries of the various schools of psychiatry. The merging sensus that still has not been achieved with regard of most of the major psychiatric schools as part of the to the concept of mental abnormality and thus men- process of diagnostic globalisation and the current tal illness. Glatzel therefore proposes replacing “ men- dominance in psychiatric diagnosis of the fi nal prod- tal abnormality ” , “ abnormal mental states ” or “ mental ucts of this process, ICD-10 and DSM-IV, has resulted illness ” with the concept of “ behavioural abnormali- in a dramatic decline in the number of “psychopathol- ties ” . However, he uses the term “ behavioural abnor- ogies ”. Today they are more of historical interest than mality ” in a much broader sense than is commonly they are able to infl uence medical-psychiatric action. the case, namely as it is used by K. Lewin (1969), who Today’ s Descriptive psychopathology is understood as by “ behaviour” understands any change in the behav- a branch of psychopathology, now mainly used for cat- ioural environment that is subject to psychological egorical diagnostics in the form of the currently pre- laws. Accordingly the term behaviour covers all pos- vailing classifi cation systems ICD-10 and DSM-IV. sible forms of human expression, including the verbal Above and beyond this, however, it is also expected to ones and not only non-verbal expressions, as is today give working psychiatrists a deeper knowledge and usually the case. Psychopathology can thus be denoted understanding of the individual psychopathological as “ … die Lehre von den vielerlei Abweichungen vom phenomena with which they are confronted in clinical Ebenma ß der Menschennatur ” (the “science of the practice when dealing with the mentally ill (Taylor and many deviations from the normal human nature” ), i.e. Vaidya 2009). as a pathoanthropology which can be exemplifi ed Functional psychopathology adopted a different, using defi cient or inappropriate or exceptional forms but certainly promising, path. Unlike classic descrip- or expressions of human nature (Glatzel 1981). tive psychopathology, its main focus is not the individual phenomenon, but instead a specifi c functional area. It does not restrict itself to describing The tasks of psychopathology individual psychopathological phenomena, but To recapitulate, the main tasks of psychopathology instead characterises them in terms of their functional can be defi ned as: Firstly , to record and describe fundamentals. The setting up and study of so-called changed behaviours and behavioural abnormalities neuro-mental modules plays a particularly important and their pathoplasticity. Secondly to explain how role here. They comprise specifi c mental functions, they come about, i.e. to study the causes and the such as neuro-cognition, perception, social cognition, pathogenetic stages underlying the development of emotion (as a “ feeling state” ), affect (as “expression ” ), behavioural abnormalities. Thirdly , to attempt to behaviour, self-concept, etc., and their corresponding understand these behavioural abnormalities which brain function systems (Gaebel et al. 2006). Modules are widely denoted as psychopathological phenom- here are regarded as sub-units of an overall system ena, to subject them to a hermeneutic interpretation which are defi ned through functions. They are not and reveal the philosophical and epistemological necessarily assigned to specifi c areas of the brain, but foundations of their manifestations. they are closely linked to neuronal networks that connect several specifi c brain regions (Calabretta and Parisi 2005; Zielasek and Gaebel 2008, 2009). From description to function From the very beginning functional psychopathol- The fi rst task, namely the description of changed ogy was strongly infl uenced by evolutionary theories, behaviours or behavioural abnormalities is the prin- in particular theories that were based on the assump- ciple aim of descriptive psychopathology. Its main tion that psychotic manifestations can be traced back 848 M. Musalek et al. to a disinhibition in which phylogenetically old behav- Since psychiatry today is a discipline straddling the ioural instances are suppressed. In this context refer- humanities and the neurosciences, psychopathology as ence should be made above all to the concept of a fi eld of basic research is granted a special integrative layers developed by John Hughlins Jackson (1932), role. However, for humanistic and neurobiological Emil Kraepelin’s (1920) teaching of “ preformed mech- modes of thinking and research to be successfully inte- anisms” of the “ human machines” and the pathogenetic grated we require stable cooperation models. What we basic formula of Kurt Heinrich (1965) according to require here is not just “ working together” in the literal which the deterioration of highly developed functional meaning of collaboration ( Latin: col – laborare), but a organisational structures or a reduction in the level of sense of joint purpose, a project undertaken for mutual cerebral function allows a form of regression to archaic benefi t as denoted by the word cooperation. Fruitful functional systems located in proximity to the brain projects can only emerge from cooperation if the fol- stem which in turn then cause the psychopathological lowing conditions are fulfi lled: (1) shared interests; (2) clinical picture of psychosis. These paleopsychopatho- coinciding aims; (3) confi dence; (4) understanding; logical theories are supported by a series of empirical (5) co-ordination; (6) proper equilibrium; (7) partner- psychophysiological, functional-topographical and ship. Each of these preconditions must be fulfi lled if neuroanatomical studies (Musalek et al. 1989; real cooperation is to take place. On account of the Rajarethinam et al. 2001; Ioannides et al. 2004, etc.). separation in the modern age (especially in recent In contrast to a purely descriptive psychopathology, decades) of scientifi c endeavour into many different, functional psychopathology also deals to a consider- highly specialised disciplines, each with its own spe- able degree with theories of explanation and thus cialised language, it has become highly problematic, if overlaps in several areas with a form of psychopathol- not impossible, for scientists to understand one another ogy known today as theoretical psychopathology and and to establish partnerships. Without mutual under- which will be examined more closely in the discussion standing, no partnership; without partnership no of psychopathology’s third main task. chance of worthwhile cooperation Finding a common language in the “ Tower of Babel” that science has become the common place and is made still more From function to aetiopathogenesis diffi cult by the many terminological overlaps and The second task of psychopathology, the study of blurred distinctions between different concepts and aetiology or pathogenesis, could of course never be defi nitions. Here theoretical psychopathology (as will managed solely with the means of clinical analysis be discussed below) with its central fi eld of conceptual such as behavioural observation, professional patient analysis has a special role to play as an intermediary interview (the psychiatric exploration, establishment and a “ translator” . of a psychopathological status) and hermeneutic Any partnership is rooted in mutual trust, which of methods. As a result, even early psychopathological course can only be established on the basis of mutual causal analyses used methods from other branches of understanding. In his Nichomanean Ethics Aristotle science in their research; on the one hand sociologi- (1998) distinguishes between different forms of cal and epidemiological-statistical methods and on friendship (philia ): friendship based on profi t, friend- the other, biological and imaging procedures such as ship based on pleasure (erotic/sexual relations), blood, urine, liquor analyses, adding later also genetic friendship based on character (which he regards as analyses. In the beginning all these scientifi c proce- “real friendship” ) and self-friendship, which he dures were completely harnessed to the needs of regards as self-refl exive intrapersonal friendship, as psychopathological research and thus effectively on the basis for all forms of friendship. Partnership, as fi rm psychopathological scientifi c ground. However, we defi ne it here, corresponds with Aristotle’s notion with increasing success in epidemiological and bio- of friendship based on profi t, which in Aristotle’s view logical research they increasingly took on a life of their can only be established on the basis of a “proper equi- own, thus appreciably neglecting and losing their psy- librium” between the two partners. Here it becomes chopathological foundations. Psychopathology as a clear what a distance there is between simply working fi eld of basic research, expected to provide the foun- together and real co-operation. Aristotelian partner- dations for aetiological and pathogenetic research, has ships are not simply a superfi cial “ coming together” hence increasingly been consigned to the margins of of equal parties to a contract. Essential prerequisites psychiatric interest. For this reason, one of the chief also include, besides shared tasks and objectives, a tasks of present and future psychopathology must be special awareness of the other and attentiveness to, as to overcome this unsatisfactory situation, which well as mutual interests and the ability to engage inhibits innovation. That said, psychopathologists in dialogue. The partnership hence also requires must do more than just re-establish the lost link reciprocity and understanding, humanistic inter- between the neurosciences and psychopathology. subjectivity and hospitality, responsibility and trust, Psychopathology in the 21st century 849 and last but not least, tactful sympathy and warmth, “ understanding ” psychopathologist is coming from, as well as confl icts and creative tension ( Clayre 1977; on what his or her perspectives and concepts are. Grice 1982; Derrida 1994; Axelrod 1997; Derrida Hermeneutic interpretation only makes sense and and Dufourmantelle 2000). only serves a purpose if in each case the psychopa- The psychopathologist must therefore provide the thologist knows the starting point and fi elds of refer- foundation for a form of cooperation capable of ence for interpretation, as well as more specifi c achieving its goals. This can be done in two ways: on reference points and frames of reference. The under- the one hand, by providing a fi rm phenomenological standing psychopathologist cannot and should not framework for teams of researchers from different focus solely on individual phenomena or areas of scientifi c disciplines; on the other, by acting as the functioning but must of course also consider the main mediator between the different research disci- theoretical foundations underlying understanding- plines in a way that fosters understanding, so as to oriented diagnosis. An understanding of the valency allow a stable basis for cooperation to be established, of psychopathological phenomena in the structure of which in turn facilitates the advancement of coopera- illness is impossible without a knowledge and under- tive research projects. One of the main tasks of psy- standing of the theoretical roots in philosophy and chopathology, both as a theoretical basic research also in the theory of science of psychopathological discipline and as a scientifi c discipline geared towards research, psychiatric practice and the treatment of practice, is to provide space for the possible to become behavioural abnormalities. Thus one of the central possible. In so doing it must play not just an accom- objectives of psychopathology is to understand and panying or supporting role but a central, leading one, to study the basis of psychopathological practice in although at the same time refraining from imposing scientifi c theory. This has to some extent been its will on the representatives of other research disci- acknowledged, for over the past two decades; a plines participating in a joint project. Only in this way branch of research has established itself – mainly will each of disciplines engaged in a psychiatry project among understanding anthropological-phenomeno- have the opportunity – on a sound psychopathologi- logical psychopathologists – that is devoted to uncov- cal footing – to develop their full innovative power. ering the basis of psychopathological theories and patterns of thinking. This has found its way into psychiatric literature under headings like theoretical Towards an integrative psychopathology psychopathology, meta-psychiatry or the philosophy of The third task of psychopathology is to gain a profound psychiatry ( Fulford et al. 2003; Radden 2004) . understanding, on the one hand of behavioural abnor- This is mainly a philosophy of psychiatry as a malities or psychopathological phenomena and, on the scientifi c and medical discipline. A philosophy of other, of the basis and starting points for psychopatho- psychiatry of this kind – in other words, a philosophy logical research, or the work of the psychiatrist. An of a particular discipline, perhaps akin to, say, a understanding of psychopathological phenomena is an philosophy of history, law or physics “ … seeks not so essential prerequisite for a psychiatric practice capable much to solve historical, physical, or legal questions ... , ” of achieving its goals. In this context we should mention or questions of clinical psychiatry, “ ... as to study the the abundance of excellent scientifi c analyses and stud- concepts that structure such thinking, and to lay bare their ies in the fi elds of clinical psychopathology and psy- foundations and presuppositions ... in this sense philoso- choanalytic and anthropological-phenomenological phy is what happens when practice becomes self-conscious ” psychopathology (see, for example, Berrios 1994; Sims ( Blackburn 1996). Hence what theoretical psychopa- 1995; Cutting 2002; Parnas and Handest 2003; thology seeks to do is not to address issues of Stanghellini 2004, etc.). Mental illness manifests itself clinical practice per se, but rather, using meta- not only in the nature of the disorder, but is in its analyses, analyses of the fundaments of psychopa- plasticity to a great extent determined by the narratives thological thinking and practice to contribute to a woven around it. These are not simply semantic and clarifi cation of seminal and relevant problems of narrative “ satellites” surrounding the state of being ill, clinical practice or of empirical science. Its main task but also play a major role as factors perpetuating illness is to refl ect on the patterns of thought and behaviour and shaping pathological events. Accordingly it is of general and specialized psychopathology. Since important that any treatment be preceded by an appro- self-refl exion always entails self-creation, and self- priate semantic analyses, so as to allow pathogenetically creation in turn forms the basis for self-refl exion – oriented treatment and above all targeted psychothera- and here we are talking about an autopoietic peutic intervention. system – this means that theoretical psychopatho logy It became clear quite early on, that an approach as a sub-discipline of psychopathology plays a central of this kind based on a psychopathology of under- role as a driving force. It thus forms the heart of psy- standing, depends to a great extent on where the chopathological research and is not limited simply to 850 M. Musalek et al. expounding theories but rather – analogous with psychiatric research, to once again shape psychiatry. theoretical physics – provides impetus and direction Applied Integrative Psychopathology must also be for empirically oriented psychopathology as well as complemented by further advancements in the fi eld for the practice of clinical psychiatry in general. of Theoretical Psychopathology, so as – in a manner The methods used most often by theoretical akin to the impact of theoretical physics on empirical psychopathology as a research discipline at the cross- physics – to enable conceptual new developments, roads between modernism and the post-modernism which can then be fruitful for cooperative research ( Bracken and Thomas 2005; Cahoone 2007) are and psychiatric clinical practice. Only in this way can deconstruction, reconceptualization or re-conception we respond adequately to Jaspers’ appeal for psy- and re-historicisation. Almost any theory with a long chiatrists to stop treating just pathological constructs enough tradition is eventually subject to a process of or categories of disorder and instead to focus once de-historicisation: in other words, the original his- again on the whole person. Integrative psychopathol- torical circumstances that gave rise to a particular ogy and theoretical psychopathology must provide theory or way of thinking or to a particular human the foundations for this, in order to shape a future construct become forgotten, and instead what are psychiatry in which the whole person once again actually human constructs come to be regarded by becomes the measure of all things. subsequent generations as natural givens. Prime examples of this include “ the soul ”, the “ sub- conscious” or “ schizophrenia” to mention just a few Acknowledgements human constructs that have acquired the status of None. natural phenomena. Only by rediscovering the origin of human constructs that have become natural givens and by revealing them for what they are does it become Statement of interest possible to refl ect on them critically again and to None to declare. examine whether they continue to be suitable models for psychopathological research or for psychiatric clinical practice. Psychopathological research and References practice not merely confi ned to explaining and under- Ammar E. 1970. Ethnopsychiatry and transcultural psychiatry: standing individual phenomena, groups of symptoms Introduction to a comprehensive understanding of psychopa- or functional areas, that do not stop at an analysis of thology in Tunisia. Tunis Med 48:295–309. the given but instead focus on the fundamentals of Andreasen NJ. 1998. Understanding schizophrenia: A silent psychiatric research and practice per se and that spring? Am J Psychiatry 155(12):1657– 9. accord a primary place to the hermeneutic synthesis Aristotle. 1998. The Nicomachean ethics (Oxford World’s Clas- sics). Oxford: Oxford University Press. of analysed fragments in the complex edifi ce of Axelrod R. 1997. The complexity of cooperation. Agent-based knowledge available to us today can provide a major models of competition and collaboration. Princeton, NJ: Prin- starting point for new developments in psychiatry. ceton University Press. Berrios G. 1994. Hallucinations: Selected historical and clinical aspects. In: Critchley EMR (ed.) The neurological boundaries Psychopathology and psychiatry of reality. London: Farrand Press. Berrios GE. 1984. Descriptive Psychopathology: Conceptual and The future of psychiatry thus lies in the hands of a historical aspects. Psychol Med 14:303–13. type of psychopathology that we will here call Inte- Blackburn S. 1996. Oxford dictionary of philosophy. Oxford: grative Psychopathology and whose main tasks are no Oxford University Press. longer identical with the traditional general psycho- Bracken P, Thomas P. 2005. Postpsychiatry. Mental health in a postmodern world. Oxford: Oxford University Press. pathology, insofar as the second main task of psycho- Bumke O. 1948. Gedanken ü ber die Seele. 4 Aufl . Berlin: Springer. pathology – that of explaining mental disorders – is Cahoone L. 2007. From modernism to postmodernism. Oxford: only possible nowadays in close cooperation with Blackwell Publishing. other branches of science. As well as precisely describ- Calabretta R, Parisi D. 2005. Evolutionary connectionism and ing psychopathological states and engaging in herme- mind/brain modularity. In: Callebaut W, Raskin-Guttmann D, editors. Modularity. Understanding the development and evolu- neutic interpretation – a task that today has received tion of complex natural systems. Cambridge, MA: MIT Press. a renewed impetus from psychotherapy – the main Clayre A. 1977. Nature and industry. Oxford: Oxford University purpose of modern psychopathology must be to lay Press. the foundations for cooperation between the various Cutting J. 2002. The living, the dead, and the never-alive: branches of research interested in studying psychiat- Schizophrenia and depression as fundamental variants of these. Haywards Heath, UK: Forest Publishing. ric issues. It is, however, not suffi cient just to provide De Figueiredo JM. 1980. Some methodological remarks on tran- the foundations for cooperation of this kind, but also scultural interviewing on psychopathology. Int J Soc Psychiatry to promote and catalyse it, in order, as the hub of 26:280–92. Psychopathology in the 21st century 851

Derrida J, Dufourmantelle A. 2000. Of hospitality. Stanford: Stan- Musalek M. 2005. Die unterschiedliche Herkunft von Schizo- ford University Press. phrenien und ihre philosophischen Grundlagen. Fortschr Neu- Derrida J. 1994. Politiques de l’amititié. Paris: Éditions Galilée. rol Psychiatrie 73:16– 24. Emminghaus O. 1878. Allgemeine Psychopathologie. Zur Ein- Musalek M, Podreka I, Walter H, Suess E, Passweg D, Nutzinger R, f ü hrung in das Studium der Geistesstö rungen. Leipzig: FCW et al. 1989. Regional brain function in hallucinations. Comp Vogel. Psychiatry 30:99– 107. Esquirol E. 1838. Die Geisteskrankheiten in Beziehung zur Okasha A. 2005. Mental Health in Egypt. Isr J Psychiatry Relat Medizin und Staatsarzneikunde vollstä ndig dargestellt. Des Sci 42:116–125. Maladies Mentales (ü bersetzt von W. Bernhard). Berlin: Voss. Parnas J, Handest P. 2003. Phenomenology of anomalous self- Fulford B, Morris K, Sadler J, Stanghellini G. 2003. Nature and experience in early schizophrenia. Comprehensive Psychiatry narrative. An introduction to the new philosophy of psychiatry. 44:121–34. Oxford: Oxford University Press. Radden J 2004. Philosophy of psychiatry. Oxford: Oxford Univer- Gaebel W, W ö lwer W, Zielasek J. 2006. Von der deskriptiven zur sity Press. funktionalen Psychopathologie. Die Psychiatrie 4:221– 32. Radford MH. 1991. Cultural infl uences on depression: A new Glatzel J. 1978. Allgemeine Psychopathologie. Stuttgart: Enke. methodological approach and its results. Jpn J Psychiatry Neu- Glatzel J. 1981. Spezielle Psychopathologie. Stuttgart: Enke. rol 45:545–64. Grice HP. 1982. Meaning revisited. In: Smith, NV (ed.) Mutual Rajarethinam R, DeQuadro J, Miedler J, Arndt S, Kirbat R, Brun- knowledge. pp. 223–243. London: Academic Press. berg JA, Tandon R. 2001. Hippocampus and amygdala in Heinrich K. 1965. Zur Bedeutung der Stammesgeschichte des schizophrenia: Assessment of the relationship of neuroanatomy menschlichen Erlebens und Verhaltens fü r Neurologie und Psy- to psychopathology. Psychiatr Res 108:79– 87. chopathologie. Homo 16:65– 77. Saravanan B, Jacob KS, Johnson S, Prince M, David AS. 2010. Hojaij CR. 2000. Editorial. Towards a psychiatric biology. World Outcome of fi rst-episode schizophrenia in India: Longitudinal J Biol Psychiatry 1(4). study of effect of insight and psychopathology. BJ Psych Husserl E. 1923/1959. Erste Philosophie (1923/1924) Zweiter 196:454–459. Teil: Theorie der phä nomenologischen Reduktion [First Phi- Scharfetter C. 1991. Allgemeine Psychopathologie. 3 Aufl . losophy (1923/1924) Second Part: theory of phenomoneologi- Stuttgart: Thieme. cal reduction] Husserliana, vol 8. Boehm R, editor. The Hague: Schipperges H. 1979. Psychiatrie in Entwicklung. Grundzü ge – Marinus Nijhoff. Schwerpunkt – Leitlinien. In: Janzarik W, editor. Psychopathol- Ioannides AA, Poghosyan V, Dammers J, Streit M. 2004. Real- ogie als Grundlagenwissenschaft. Stuttgart: Enke. time neural activity and connectivity in healthy individuals and Schneider K. 1946/1980. Klinische Psychopathologie. 12 Aufl age. schizophrenia patients. NeuroImage 23:473 – 82. Stuttgart: Thieme. Jackson JH. 1932. Selected writings. New York: Hoddor & Sims A. 1995. Symptoms in the mind. An introduction to descrip- Stoughton. tive psychopathology. 2nd edition. London: Saunders. Jaspers K. 1913/1973. Allgemeine Psychopathologie. 1– 9 Aufl age. Stanghellini G. 2004. Disembodied spirits and deanimated Berlin: Springer. bodies. Oxford: Oxford University Press. Kojo K. 2010. Late-onset schizophrenic syndromes in socially St ö rring G. 1900. Vorlesungen ü ber Psychopathologie in ihrer isolated situations: A comparison of Janzarik’s “Kontaktman- Bedeutung fü r die normale Psychologie. Leipzig: Engelmann. gelparanoid” and late paraphrenia. Psychogeriatrics 10:83–9. Taylor MA, Vaidya NA. 2009. Descriptive psychoapthology. Kraepelin E. 1920. Die Erscheinungsformen des Irreseins. Z The signs and symptoms of behavioral disorders. Cambridge: Neurol Psychiatr 62:1– 29. Cambridge University Press. Krafft-Ebing R. 1879. Lehrbuch der Psychiatrie. Bd I– III. Stutt- Téllez Carrasco PJ. 1985. Transcultural psychopathology of delu- gart: Enke. sions in Venezuela. Actas Luso Esp Neurol Psiquiatr Cienc Lewin K. 1969. Principles of topological psychology. New York: Afi nes 13:245–8. Johnson Reprint Corp. Zielasek J, Gaebel W. 2008. Moden modularity and the road Musalek M. 2003. Meaning and causes of delusions. In: Fulford towards a modular psychiatry. Eur Arch Psychiatry Clin Neu- B, Sadler J, Stanghellini G, Morris K, editors. Nature and nar- rosci 258(Suppl 5):60– 5. rative. International perspectives in philosophy and psychiatry. Zielasek J, Gaebel W. 2009. Modularity in philosophy, the neuro- Oxford: Oxford University Press. sciences, and psychiatry. Poiesis Prax 6:93 – 108.