Future developments

As for the future, we are in agreement with the ideas recently expressed by Wiggins and Schwartz. (36) Phenomenology can contribute to psychiatry firstly by allowing an understanding of mental illnesses beyond the mind-body dualism, and secondly by enforcing a rigorous scientific method. In doing this, it can highlight aspects of psychopathology which differentiate, for example, delusions in schizophrenia, mania, and exogenous psychosis. (3D

Finally we suggest a critique of psychiatric phenomenology and at the same time offer some solutions. The application of the phenomenological method in psychiatry always results in the determination of a 'loss' of something owned by the healthy person, a problem also identified by Broekman. (38) For example, we talk of the 'loss of natural evidence' (Blankenburg) or the 'loss of the coherence of natural experience' (Binswanger). The search for the mere deficiency can mean that phenomenology appears to be only the translation of psychopathological concepts into another language; for example, instead of schizophrenic 'devastation' (Verblödung) one speaks of 'existential withdrawal' (Rückzug). We see only one way of overcoming this difficulty, and that is to develop a positive phenomenological understanding of psychopathological deviations. This means that they should be understood not as mere deficiencies, 'but as the emancipation of particular aspects of human reality, which in the healthy person remain integrated'.(39) In the case of delusions (phenomena pertaining to the realm of intentional acts which fixate reality and solidify themselves in judgements), Blankenburg has demonstrated how the normal constitution of a judgement about reality appears itself as a delusional formation in statu nascendi which is permanently being corrected or abolished. In delusion there is an emancipation and radicalization of human possibilities, for instance the capacity to proceed from the particular to the general or the imagination of things that are beyond reality or the zealous search for truth. Doerr-Zegers and Tellenbach(37) have shown how delusion and truth are closely related. Strictly speaking, delusion possesses almost all the attributes of truth, even its capacity to illuminate (in the sense of the Greek aletheia); however, its radicalizing character leads to blinding and isolation of the patient.

This phenomenological-dialectic perspective is of interest for psychopathology in two ways. The first is that it allows one to understand those styles of experience and behaviour which appear in our daily clinical practice not as a pure deviation from a presupposed norm, but as behaviours which exist in their own right. The second is the positive view of the negative, originally developed by Hegel and applied to psychiatry by Blankenburg (l0) and later by Doerr-Zegers/lP This approach directs attention not only to the deficiencies of schizophrenic patients (what is negative), but also to the many positive aspects, such as their metaphysical sense, their capacity to perceive nuances of reality which are bewildering to average people, and their search for an uncompromising truth. (37) The same approach could be adopted for depressive, hysteric, or obsessive patients. The depressive personality displays loyalty to social norms, a high work performance, and self-oblivion. The hysterical personality adapts to any context, possesses a great capacity for emotional warmth, and is an outstanding entertainer. The obsessive patient displays a strong capacity to carry out projects, a sober appearance, and scrupulous care in relations with other persons.

This way of thinking is not only of theoretical but also of practical importance. When psychiatrists do not simply take the negative view, they will be forced to widen their horizons of understanding, change their frames of reference, and question the traditional concept of illness. Furthermore, from this perspective psychopathological states appear as polarities (e.g. schizophrenia versus depression or hysteria versus obsession) with multiple transitions which correspond to clinical experience rather than fixed nosological categories. The observation of the positive aspects of psychopathological states leads to improved methods of therapeutic action. Thus the doctor should avoid merely adapting the patient to a norm which in reality does not exist. Instead, the patient is made aware of the positive values of features that are often defined as abnormal and helped to develop in the opposite direction, towards the other pole, for example from the schizophrenic to the depressive pole and vice versa. In doing this, the existential-phenomenological attitude helps the patient to approach what the Ancient Greeks called 'measure' which, according to Aristotle, is the perfect position between two imperfect extremes. As Heraclitus stated, '[In the end] what is cold gets warm, what is warm gets cold, what is humid gets dry, and what is dry gets humid' (Fragment 126).

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