Psychiatry and existential-phenomenological psychiatry

In the twentieth century, psychiatry is experiencing a time of active transformations, and these transformations it finds its modern face of science, its methodology, theory and practice. It is the last century that accounts for the development of psychopharmacology, the development of the main directions of psychotherapy and social adaptation of patients, as well as many theoretical innovations from infectious to philosophical hypotheses of the origin of mental disorders.

This important time for psychiatry itself is accompanied by changes in the development of science as such: the strengthening of interdisciplinary interactions, the activation of ethical and anthropological issues, a turn to methodology. Science, keeping attention to its subject, turns to itself, interpreting its own development. “Since Einstein and Heisenberg, – writes Klaus derner, – natural scientists have been tormented by the question of the legitimacy and validity of their activities in the face of both the limitless possibilities and the dangers of modern natural science. And perhaps it is good that our whole life depends more on the honesty and constancy of this “self-torture” than on other actions of natural scientists. <…> In short, since in the nineteenth century naturalists celebrated the victory of independence of their science, break the shackles of philosophy in the twentieth century they are trying to restore the organizing role of philosophical thinking. They painfully engage in self-reflection” . Psychiatry is no exception.

From both philosophy and the psychiatry is a movement towards each other becomes a reflection characteristic of the XX century trends of interdisciplinarity. Philosophy expands its boundaries and turns to the previously marginal for her subject spaces, trying to develop them through the problems of their traditional sections, as well as to understand their own status. Psychiatry beginning of the XX century is experiencing a crisis of explanatory hypotheses and interpretation schemes. In the Wake of methodological disputes, it begins to understand itself not only as a branch of medicine and natural science, but also as a science about a person, although a mentally ill person. In such a situation, philosophy provides it with methodological and conceptual support for criticism of its own grounds. And formed the philosophical in its paradigmatic nature, the direction of psychiatry.

The process of interaction of philosophy and psychiatry appears as the development and change of philosophical paradigms of psychiatry: 1) Humanities paradigm (S. Freud, J. Bleuler, H. Prichina) to 1930-x years; 2) the existential-phenomenological paradigm (phenomenological psychiatry, and existential analysis) – 1930-1960-ies; 3) socio-critical paradigm (antipsychiatry) – 1960 – late 1980s; 4) the philosophy of psychiatry from 1990-ies.

The gradual humanitarization of psychiatry begins with the “small” psychiatry – the vast part that deals with neuroses and personality disorders. Such humanization and parapsihologicheskie contribute to psychoanalytic theory and relevant practice of the treatment of neuroses: dynamic psychiatry P. Jean, psychoanalysis, Freud, analytical psychology of C. G. Jung, the individual psychology of A. Adler, etc., “Humanization” of neurotics becomes a necessary prerequisite for the humanization of psychiatry. Many of the explanatory hypotheses and methods developed in the psychiatry of neuroses and psychoanalysis, later begin to be used in relation to patients with psychosis. A role at this stage will play psihonarkologicheskiy research. First, it is a study of the types of temperaments and psychopathies (E. Kretschmer, W. Sheldon, etc.) that contributed to the construction of the vector “norm – psychopathy – disease”. Secondly, it is the study of the creativity of gifted patients, representing the disease as a unique, embodied in the art of vision.

These trends in neurosis psychiatry are supported by the rapid development of anthropology and Ethnology and by field studies of norm and pathology in primitive cultures. In the end gradually is made common to the Humanities and psychiatrists in the space of interest and reflection. In the early 1950s, Gregory Bateson and jürgen Ruche wrote: “Today, in the middle of the twentieth century, humanitarians and clinicians are making every effort to better understand each other. Moving away from dogmatic concepts and getting rid of scientific isolation is the fashion of our time” .

This humanitarian-psychiatric space then still remains a space of common interests and overlapping problems. The process of methodological self-reflection of psychiatry and its direct appeal to philosophy will be associated only with the formation of existential-phenomenological psychiatry.

Existential-phenomenological psychiatry – a direct precursor to anti-psychiatry: without the first would have been impossible second . It is a tradition that combines phenomenological psychiatry and existential analysis, or Dasein analysis. It is initially based on the philosophical paradigm and philosophical setting, so on its grounds it is more philosophical than medical, psychiatric direction. It launches mainly the development of phenomenology and existential philosophy and their extensive spread to the applied space of psychiatry. These philosophical influences are supplemented by the descriptive psychology of W. Dilthey and understanding sociology of M. Weber, philosophical anthropology of M. Scheler and phenomenology of the Munich circle, neo-Kantianism of P. Natorp and intuitivism of A. Bergson.

Traditionally, phenomenological psychiatry include the ideas of Karl Jaspers, E. Minkowski, E. Strauss, and V. E. von Gebsattel; to the existential analysis, or Dasein-analysis – the views of L.’s Binswanger’s, M. Boss and their followers: R. Kuhn, A. Storch, K. Kulenkampf, V. Blankenburg, G. Tellenbach, Condrau etc. the Followers of existential-phenomenological psychiatry in all countries of Europe, and it provided in effect truly revolutionary: it considerably contributed to the humanization of psychiatry; it became the main space for understanding the methodological foundations of psychiatry itself, the space of its philosophical self-reflection; and finally, it was thanks to her that later formed humanistic psychology, one of the three Central to date areas of psychology and psychotherapy.

Existential-phenomenological psychiatry was formed in the 1920s, the official date of her birth is November 25, 1922. On this day at the meeting of the Swiss psychiatric society, reports were made by Eugene Minkowski and Ludwig Binswanger. The rapid development of this movement (at least in the works and projects of the main representatives) occurs mainly in the period up to the early 1960s, when it cedes its leading position in the arena of philosophical and psychiatric areas of antipsychiatry.

The movement itself is diverse both in its ideas and methodological settings, but all its representatives are United around the philosophical interpretation of mental illness and its consideration in the context of the patient’s existence. In existential phenomenological psychiatry, the disease is transformed from a medical to an anthropological and existential phenomenon. This understanding is formed on the basis of the appeal of psychiatry to the ideas of phenomenology, existential philosophy and other related currents and theories.

Existential-phenomenological psychiatry brings the interaction of philosophy and psychiatry to a fundamentally different level, presenting the first experience of the formation of philosophical and clinical space of reflection and self-reflection. The second such experience will be antipsychiatry. In this space, the resulting integrity is much more than its constituent parts and even more than their sum. For the most existential-phenomenological psychiatry it will become possible thanks to five decisive steps:

1) methodological and subject self-reflection;

2) rehabilitation of pathological experience;

3) humanization of the patient;

4) interpretation of the disease of existence;

5) the Constitution meantime.

The tradition of existential-phenomenological psychiatry arises in the General for all Sciences situation of interdisciplinarity. Here is how this situation Ludwig Binswanger: “it Is a time when a separate science, fear, dissociate themselves from philosophy when they are in critical arrogance disregard the existence of direct and positive pride, forget about the problematic nature of their own nature. Today, philosophers and scientists, critics and creators, with full awareness of the limits of their method, turn to each other for joint cooperation. The development of neo-Kantianism, Dilthey’s research and phenomenological movement – all this pointed to the possibility of interaction between science and philosophy, which has the ultimate goal of understanding the Sciences themselves” .

Binswanger here notes the main directiona

In the framework of existential-phenomenological psychiatry is a kind of problem-methodological bias. If the classical traditional psychiatry conceptualizes itself as a science of mental illness and explores the causes, content (symptoms and syndromes) and principles of treatment of mental disorders, in existential-phenomenological psychiatry, along with a change in orientation comes a change in the problem field: the person as such begins to be investigated, the person as a whole, his life-history, and the main subject space becomes a pathological experience as a full experience of himself and the surrounding reality.

Antipsychiatrists will continue the tradition of neo-Kantian questioning about the status of their own science and will insist that psychiatry cannot be viewed in the likeness of the natural Sciences and that it deals with man and his problems. As Thomas SAS will emphasize: “We know that a person can only gain personal integrity through an open awareness of his / her historical background and a reliable assessment of his / her unique features and potential. This is also true for the profession or science. Psychiatry will not be able to achieve professional integrity, in imitation of the medicine, and the integrity of the scientific by imitating physics. It will be able to achieve this integrity and, therefore, respect for itself as a profession and recognition as a science only through courageous opposition to its origins and honest assessment of its true features and potential” .

Phenomenology brings new optics to psychiatry, which equally affects both its theory and its practice. As Husserl wrote: “Instead of dissolving in acts arranged in different ways on each other and at the same time objects, the meaning of which is meant, so to speak, naively to believe as existing, to determine them or to put forward hypotheses concerning them, to deduce consequences, etc., we must, on the contrary, “reflect”, i.e. make the acts themselves objects in the immanent semantic content” .

Psychiatrists focus not on behavior, not on symptoms, but on the inner experience of the patient himself. “Pathological consciousness itself” becomes a psychiatric analogue of Husserl’s “things themselves”, around the aspiration to which the camp of existential phenomenological psychiatrists is United. Here to active use, includes phenomenological reduction, even more, reducing the installation. In psychiatry at the beginning of the century, with an abundance of theories and concepts, its necessity was realized more clearly than ever. Carl Jaspers, one of the methodological founders of existential phenomenological psychiatry, recalled: “Each of the schools had its own terminology. It seemed that the conversation was in completely different languages, local dialects of these languages existed in every clinic. <…> There was a feeling that I live in a world where there is an immense variety of points of view that can be taken in any combination, and individually, but they are all simple and artless to the point of non-belief” [16] . Phenomenological reduction leads away from theories and numerous hypotheses, from symptoms and syndromes, from behavior and external indicators and opens for the psychiatrist the world of the patient’s experience. The experience itself, the experience itself, is that in existential phenomenological psychiatrists it remains as a phenomenological remnant after passing the stage of phenomenological reduction and that comes to the place of Husserl consciousness.

Rejection of theories and hypotheses leads to a descriptive orientation of existential-phenomenological psychiatry. And here the influence of Husserl’s phenomenology is supplemented by descriptive psychology, V. Dilthey. Followed Karl Jaspers calls to abandon inapplicable in psychology and psychiatry explain and refer to the world of experiences of the patient. The main method of this descriptive psychology is the method of understanding – intuitive penetration and comprehension of the relationship of phenomena.

Such an unappreciated understanding leads to the rehabilitation of pathological experience: pathological experiences, pathological world become equal to the world and the experience of most people. The phenomenological reduction of Husserl removes the question of the truth and fantasy of the experience of consciousness – for him reality and fantasy are ontologically equal. Phenomenological reduction of existential-phenomenological psychiatry removes.

The rehabilitation of pathological experience, which occurred only thanks to philosophy, leads to a change in worldview. For the XIX century. characteristic and generally accepted was the theory of degeneration, and the patient, which is natural in this interpretation of his disease, was recognized as a subhuman. It was thought that mental illness he is degraded to the animal state, this degradation was irreversible, the treatment was considered useless, and the only method would be to drill. Mentally ill, becoming such, forever lost their capacity and human face, so the treatment of them for the most part was like animals, and therefore kept them in “non-human” conditions.

In the humanistic revolution of psychiatry early XX centuries played a role in the many factors, the most important of these was the development of existential-phenomenological psychiatry. The first world war brought Europe a surge of cases of military neuroses and, as a consequence, the influx of psychological techniques. Advances in psychopharmacology have led to the possibility, albeit slight, but relief of acute symptoms and slowing the process of degradation. A powerful existential wave in culture and philosophy made us think about human life, suffering and relationships between people, forced us to recognize that it is necessary to treat a person as a person. All these factors have prepared the ground for what existential phenomenological psychiatry has done.

Turning to the very reality of the disease, looking at the patient, existential-phenomenological psychiatry saw in him a man, although somewhat different from the rest. Positioning itself as a science of man, it introduced new criteria for the separation of normal and pathological. The mentally ill, as its representatives say, like everyone else, lives in the world, perceives it, acts in it, only it does so on the basis of another mode of existence, not similar to the mode of existence of most people. “…The disease is primarily a way of human existence” , – emphasizes V. E. von Gebzattel.

The interpretation of the disease as the mode of human existence, the mode of existence of the patient, leads to a more attentive attitude to the personality, “pathological” existence of which is revealed to the psychiatrist. Pathological experience begins to be understood not as an experience in itself (and here existential phenomenological psychiatry departs from the principles of phenomenology), but as someone’s experience, and the world – as the world of this particular patient. The works of existential phenomenological psychiatrists abound not so much in clinical cases as in life stories and confessions of patients about their experiences. “Disease as such does not exist, – emphasizes Medard Boss. – Stomach and stomach disease, thinking and General paralysis are non-existent abstractions. But my hand, my stomach, our instincts, your thoughts are real. Strictly speaking, just the mention of my, your or their painful existence refers to something real. Possessive pronouns of everyday language, used to describe the reality of being sick, all indicate the existence that is preserved and revealed in the history of life” .

In the world of normal people, the mentally ill therefore appears as an existential stranger, as a foreigner. His experience of the world is not like that of other people, his image of himself is different from the average image. It is this alienation, according to most representatives of existential phenomenological psychiatry, and is designated in the term “mentally ill”. The patient is thus recognized as a person, but the person is existentially different. Erwin Strauss explains: “the Outdated expressions ‘psychiatrist’ and ‘madhouse’ still remind us that otherness is the criterion on which clinical observation and scientific research are built. Psychotic symptoms at least indirectly indicate a standard that the patient does not meet”.

Existential-phenomenological psychiatry developed the ideas of phenomenology and existential philosophy in the space of the science of mental diseases, so the criterion for the identification of mental illness was for her existential alienation. Antipsychiatry will be a product of the era of the 1960s, so the reference point for it will not be existential, but social philosophy, and the criterion of differentiation of mental illness will be social alienation.

However, the representatives of existential-phenomenological psychiatry is not just characterize the pathological experience as an existential other, but also describe in detail the main vectors. As Roland Kuhn notes: “the Main idea of this course is not to expand psychopathology, but to take existence as its starting point and show in what sense the psychopathological approach to the patient represents a deficit modification of existence” . For each of the representatives, this picture of the pathological is built in the vectors of space and time, but is described in different languages, depending on the priority philosophical borrowings.

Eugène Minkowski considers the fading of “personal impulse”to be a feature of pathological experience. Creatively developing the concept of life impulse A. Bergson, he characterizes the personal impulse as the direction of human life forward, personal formation, striving for new frontiers and new goals. In schizophrenia, in his opinion, this impulse fades away, which leads to a slowdown in the time flow, to detachment from it, to the loss of contact with reality and with other people. Life and personality at the same time lose their integrity and disintegrate into fragments, becoming blocked, and a person can no longer move on, design their behavior and even simply live in the present, because it is impossible without connection with the past and the future.

Erwin Strauss builds his concept of pathological experience like Minkowski, calling one of its main features blocking temporality and formation. “Since the experience of time is a fundamental space of experience in General, – he writes, – there are transformations of this experience that determine other experiences, thoughts, actions and their results due to dependence both in form and in content, on these transformations”. He describes mental illness in the framework of estesiology – the science of direct, prepositional, sensory experience – and characterizes schizophrenia as a change in relations with the outside world, or rather, as the loss of boundaries between the “I” and Other surrounding objects and people. Personal space invades the General social space, and so there are ideas of influence, the social crosses the boundaries of the personal, leading to ideas of influence, voices, embedded thoughts and obsessive behavior.