The concept of paranoia refers to a main problem of general psychopathology: Paranoia represents the prototype of a pure delusional disorder. The text reviews the descriptive psychopathological and nosological aspects of paranoia which is orientated towards the well-known historical studies by Kraepelin, Gaupp, Kretschmer and Jaspers. The systematic character of the delusional ideas and a specific emotional-affective state connected with a typical (sensitive-vulnerable) personality constitute the "classical" concept of paranoia. Furthermore, the characteristics of paranoia experience and its distinction from delusion during schizophrenic disorders are discussed. The possibility of communication with a delusional person in his autistic world calls for our understanding of the inner and existential meaning of delusion. Therefore the research into the problem of paranoia requires consideration of phenomenological, philosophical and anthropological points of view.
In this study delusion is regarded from the aspect of a phenomenology of imagination. Delusion as an experience of fictitious actualities is interpreted as the attempt of a psychotic person, to find a sense of existence in view of the threat by mental illness. After explaining the philosophical fundamentals, imagination is considered to be the dynamic origin of delusion and hallucinations. The discussion of psychopathological and clinical problems is followed by a demonstration of further phenomenological and hermeneutic approaches.
Phenomenological psychiatry examines the variety of psychiatric diseases as regular modifications of human feeling tone experience and behaviour, which can be derived approximately from the nature of man as defined philosophically, Interdisciplinary self-conception of phenomenological psychiatry as a science calls for a constant critical dialogue with the philosophy of man and other disciplines of the humanities. The point of departure of phenomenological psychiatry is the mental or affective illness of the individual patient, with which the psychiatrist is acquainted, and reflects in interpersonal encounters in such a way that individual case studies are of central importance in this area of studies. From a methodological point of view two approaches are to be differentiated within the field of research in phenomenological psychiatry: 1. The phenomenological approach is concerned with the analysis of specific patterns of disturbance of the transcendental organisation of psychotic subjectivity. 2. The interpretative approaches are again divided into the so called "Daseinsanalyse" as a hermeneutic access to the inner biography and "Weltanschauung" of the psychiatric patient as well as the attempts of understanding the meaning of psychotic forms of experience. In this context a survey of the current fields of research of phenomenological psychiatry is given which aims at a deeper understanding of the situation of psychiatric patients and which claims to have a strong relevance for therapy. The relevance of such a phenomenological approach for current psychiatry lies in a broadening and sophistication of our experience in clinic and practice. Its main interest lies in the concentration on the patient as an individual and on the existential dimension of forms of mental and emotional diseases.
Working on the principle that anxiety is interpreted as a sorrowful and uncanny experience of being fundamentally imperiled, the clinical phenomena of anxiety are examined taking into account the historical aspects of the problem of anxiety. As a nosological term anxiety implies the establishment of anxiety diseases such as anxiety neuroses and the manifold phobiae. Anxiety can generally be understood as the dynamic basis of neurotic diseases. In the assessment of the range of this problem in a scientific way, the development of psychoanalytical theories plays an important role. There is also a level of symptomatology where the importance of anxiety in the pattern of symptoms belonging to various mental illnesses must be given consideration. This is where the phenomenon of anxiety as part of a psychosis becomes a crucial psychopathological problem which, in its complexity, is taken care of rather insufficiently in current psychiatric discussions. The possibilities offered by a phenomenological and hermeneutic approach are pointed out, leading to the fundamental importance of anxiety that structures human experience in psychosis. The clinical empiricism of the phenomena of anxiety gives rise to first attempts to formulate a theory and a concept of anxiety: Side by side with the somatological constructions and psychoanalytical theorems, there is the approach of a psychiatry drawing from the fields of philosophical anthropology aiming at understanding. The attention paid to anxiety by psychiatry during the Romantic era before Griesinger, as well as the reasons for the differentiation between anxiety and fear, owing to the history of thought and concept, are dealt with separately. Looking at the history of the problem of anxiety, where psychiatric science always maintains its links with prevalent concepts of its era, we can recognize the continuity of the ever identical transhistorical problem structures of anxiety in their relevance for the questions formulated by today's psychiatry. Since it enables us to differentiate between what can be scientifically elucidated and what evades the grasp of science, it is quite evident that psychiatric thinking guided by philosophic interpretation remains a necessity even today--not least with regard to the attitude towards the patient suffering from anxiety.
Philosophische Voraussetzungen der anthropologischen PsychiatrieDas Aufzeigen anthropologischer Aspekte seelischen Andersseins ist das Ziel der anthropologischen Psychiatrie, die in der deutschsprachigen Psychopathologie auf eine jahrzehntelange Forschungstradition zurückblicken kann (Passie 1995).Die historische Begründung dieser Richtung ist mit den Namen von L. Binswanger, V. E. von Gebsattel und E. Straus verknüpft; stellvertretend für die Kontinuität dieses Forschens seit dem 2. Weltkrieg seien hier die Arbeiten Tellenbachs, von Baeyers und Zutts sowie bis in die jüngste Gegenwart von Blankenburg genannt. Phänomenologisch-anthropologische PsychiatrieDas in seinen theoretischen Ausgangspunkten durchaus differente Spektrum dieser anthropologischen An-sätze konvergiert in dem Bemühen, über die Deskription der klinisch beobachtbaren Erlebens-und Verhaltensauffälligkeiten hinaus das sich im Symptombild ausdrückende und seine Existenzweise bestimmende Selbst-und Weltverhältnis des Kranken zu erfassen. Das Erfahrungs-und Forschungsfeld dieser sog. phänomenologisch-anthropologischen Psychiatrie läßt sich in problemgeschichtlicher wie systematischer Hinsicht nur in seiner Verschränkung mit den unterschiedlichen, die einzelnen Fragestellungen vorgebenden philosophischen Konzeptionen vom Wesen des Menschen verstehen (Tellenbach 1987). Psychiatrie und Philosophie"Anthropologisch" bezeichnet dabei nicht nur den Gegenstand dieses Forschens, also den Menschen, sondern auch das Bemühen, einen der Eigenart der "menschlichen Natur" (Kunz 1963) angemessenen Logos des wissenschaftlichen Vorgehens zu finden. Hier zeigt sich ein thematischer Wechselbezug zwischen Philosophie und Psychiatrie, wobei die erstere für den Gang ihres Denkens auf bestimmte klinisch-psychiatrische Erfahrungstatsachen angewiesen ist, während andererseits der Psychopathologie das Erfordernis einer selbstkritischen philosophischen Besinnung ihrer Grundbegriffe deutlich wird (Blankenburg 1979;Frick 1993). Einflüsse philosophischer SchulenHervorzuheben sind insbesondere die Einflüsse der phänomenologischen Bewegung in der Nachfolge Husserls, der Lebensphilosophie (Bergson), der philosophischen Hermeneutik (Dilthey, Gadamer) und der philosophischen Anthropologie (Scheler, Plessner) sowie der Daseinsanalytik Heideggers.Anthropologische Forschung in der Psychiatrie vollzieht sich also in einem wechselseitigen Begründungsverhältnis von lebensweltlich verankerter qualitativnatürlicher Erfahrung und übergreifendem konzeptuellem Entwurf, wobei der methodologischen Reflexion auf den Gang des Erkennens und seiner Voraussetzungen eine zentrale Bedeutung zukommt.
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