Chapter References

1. Brentano, F. (1925). Psychologie vom empirischen Standpunkt. Meiner, Leipzig.

2. Husserl, E. (1962). Husserliana, Vol. IX,Phänomenologische Psychologie. Nijhoff, The Hague.

3. Fink, E. (1958). Studien zur Phänomenologie. Nijhoff, The Hague.

4. Broekman, J.M. (1965). Phänomenologisches Denken in Philosophie und Psychiatrie. Confinia Psychiatrica, 8, 165-87.

5. Blankenburg, W. (1962). Aus dem phänomenologischen Erfahrungsfeld innerhalb der Psychiatrie. Schweizer Archiv für Neurologie, Neurochirurgie und Psychiatrie, 90, 412-21.

6. Goethe, W. (1966). Naturwissenschafte Schriften II, Sprüche in Prosa, No. 172. Artemis, Zürich.

7. Jaspers, K. (1963). Die phänomenologische Forschungsrichtung in der Psychopathologie. In Gesammelte Schriften zur Psychopathologie, pp. 314-28. Springer, Berlin.

8. Jaspers, K. (1963). Allgemeine Psychopathologie. Springer, Berlin

9. Berrios, G.E. (1989). What is phenomenology? Journal of the Royal Society of Medicine, 82, 425-8.

10. Wiggins, O.P., Schwartz, M.A., and Spitzer, M. (1992). Phenomenological/descriptive psychiatry: the methods of Edmund Husserl and Karl Jaspers. In Phenomenology, Language and Schizophrenia (ed. C. Mundt), pp. 1-25. Springer, New York.

11. Wiggins, O.P. and Schwartz, M.A. (1997). Edmund Husserl's influence on Karl Jaspers' phenomenology. Philosophy, Psychiatry, and Psychology, 4, 15-36.

12. Binswanger, L. (1947). Über Phänomenologie. In Ausgewählte Vorträge und Aufsätze, Vol. I, pp. 13-49. Francke, Bern.

13. Heidegger, M. (1963). Sein und Zeit (10th edn). Niemayer, Tübingen.

14. Binswanger, L. (1947). Über die dasesinsanalytische Forschungsrichtung in der Psychiatrie. In Ausgewählte Vorträge und Aufsätze, Vol. I, pp. 190-217. Francke, Bern.

15. Binswanger, L. (1945). Über die manische Lebensform. In Ausgewählte Vorträge und Aufsätze, Vol. II, pp. 252-63. Francke, Bern.

16. Binswanger, L.(1957). Schizophrenie. Neske, Pfullingen.

17. Binswanger, L. (1960). Melancholie und Manie. Neske, Pfullingen.

18. Binswanger, L. (1965). Wahn. Neske, Pfullingen.

19. Szilasi, W. (1959). Einführung in die Phänomenologie Edmund Husserls. Niemayer, Tübingen.

20. Kisker, K.P. (1961). Die phänomenologische Wendung Ludwig Binswangens. Jahrbuch für Psychologie, Psychotherapie und Medizinische Anthropologie, 8, 143-153.

21. Tellenbach, H. (1962). Abbreviatur und Epikritisches zu Ludwig Binswanger's Buch 'Melancholie und Manie'. Nervenarzt, 33, 515-20.

22. Blankenburg, W. (1971). Der Verlust der natürlichen Selbstverständlichkeit. Enke, Stuttgart.

23. Mishara, A. and Schwartz, M.A. (1997). Psychopathology in the light of emergent trends in the philosophy of consciousness, neuropsychiatry and phenomenology. Current Opinion in Psychiatry, 10, 383-9.

24. von Gebsattel, V.E. (1954). Prolegomena einer medizinischen Anthropologie. Springer, Berlin.

25. Straus, E. (1960). Psychologie der menschlichen Welt. Springer, Berlin.

26. Minkowski, E. (1933). Le temps vécu. Collection de L'Évolution Psychiatrique, Paris.

27. López-Ibor, J.J. (1950). La angustia vital. Paz Montalvo, Madrid.

28. Zutt, J. (1963). Auf dem Wege zu einer anthropologischen Psychiatrie. Springer, Berlin.

29. Doerr-Zegers, O. (1997). Psiquiatría antropológica (2nd edn). Universitaria, Santiago.

30. Tellenbach, H. (1983). Melancholie (4th edn). Springer, Berlin.

31. Tellenbach, H. (1992). Schwermut, Wahn und Fallsucht in der abendländischen Dichtung. Pressler, Hürtgenwald.

32. von Zerssen, D. (1982). Personality and affective disorders. In Handbook of affective disorders, pp. 213-28. Churchill Livingstone, New York.

33. Pelicier, Y. (1987). Asthme, souffle et culture. Psychologie Médicale, 19, 1849-50.

34. Tatossian, A. (1979). Phénoménologie des psychoses. Masson, Paris.

35. Naudin, J. (1997). Phénoménologie et psychiatrie. Presses Universitaires du Mirail, Toulouse.

36. Wiggins, O. and Schwartz, M. (1997). Psychiatry. In Encyclopaedia of phenomenology (ed. L. Embree), Vol. 18. Kluwer, Boston, MA.

37. Doerr-Zegers, O. and Tellenbach, H. (1980). Differentialphänomenologia des depressiven Syndroms. Nervenarzt, 51, 113-18.

38. Broekman, J. (1998). Schizophrenie als Erkenntnisproblem. Fundamenta Psychiatrica, 12, 47-52.

39. Blankenburg, W. (1985). Perspectiva antropológica y analítico-existencial del delirio. Revista Chilena de Neuropsiquiatría, 23, 165-78.

40. Blankenburg, W. (1981). Wie weit reicht die dialektische Betrachtungsweise in der Psychiatrie? Zeitschrift für Psychiatrie und Psychotherapie, 29, 45-66.

41. Doerr-Zegers, O. (1990). Hacia una concepción dialéctica en psiquiatría. Actas Luso-Españolas de Neurología y Psiquiatría18, 244-57.

Glen O. Gabbard

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Psychodynamic psychiatry is broadly defined today. In fact, the term psychodynamic is now used almost synonymously with psychoanalytical. Freud originally used the term psychodynamic to emphasize the conflict between opposing intrapsychic forces: a wish was opposed by a defence, and different intrapsychic agencies, such as ego, id, and superego, were in conflict with one another. Indeed, for much of the twentieth century psychoanalytical theory was dominated by the drive-defence model, often referred to as ego psychology.

In the last decades of the twentieth century, however, the hegemony of ego psychology waned, and other models of the mind gained wide acceptance. Through the influence of Melanie Klein and the British School of object relations, psychoanalytical theory expanded beyond the notion of conflict among intrapsychic agencies. Internal object relations became paramount in models deriving from these sources. In addition, a deficit model of symptomatology arose from the work of the British object-relation theorists, such as Balint and Winnicott. In the United States, Kohut's self-psychology also developed a model based on developmental deficits. In other words, disturbed patients who came to treatment were seen as suffering from absent or weakened psychic structures based on developmental failures by parents or caretakers in the early childhood environment. (See Chapiei,3 2 for an account of the development and modern practice of psychoanalysis.)

As a result of these innovations in psychoanalytical theory, psychodynamic psychiatry is practised today in an era of pluralism. The typical psychodynamic psychiatrist then uses multiple models to assist in the understanding of a particular patient. Moreover, the diagnostic and treatment approach to an individual patient is psychodynamically informed even when a decision has been made to forego psychodynamic psychotherapy. Psychodynamic thinking provides a conceptual framework within which all treatments are prescribed, including pharmacotherapy, psychotherapy, inpatient or partial hospital treatment, and group or family modalities. Psychodynamic psychiatry is not synonymous with psychodynamic psychotherapy.

A comprehensive definition of current psychodynamic psychiatry is the following:(1)

Psychodynamic psychiatry is an approach to diagnosis and treatment characterized by a way of thinking about both patient and clinician that includes unconscious conflict, deficits and distortions of intrapsychic structures, and internal object relations.

In this definition emphasis is placed on the presence of two individual psychologies or subjectivities that interact in the field of treatment. Clinicians must recognize that their own unconscious beliefs, biases, and feelings will inevitably influence the way they view the patient.

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