British Phenomenological and Psychopathological Concepts: A Comparative Review

Abstract

For a foreign observer who has been trained in German and French psychopathology, British psychiatry is very attractive at first glance for a number of reasons. Its eclectic and principally non-theoretical approach (Cooper, 1975), characterized by an open acceptance of foreign concepts and by the tendency to question traditional structures and hypotheses and to test them by means of statistical methods, appears most impressive. The substantial contribution British authors have made toward the development of structured tools in psychopathology, like for instance the Present State Examination or the Hamilton Rating Scale in order to facilitate such a statistical evaluation, which reflects clearly the inheritance of Sir Francis Galton, is also a cause of sincere admiration. The European observer realizes furthermore that the British approach is rooted mainly in continental, especially in German, clinical psychiatry, and is not as heavily influenced by psychodynamic theories as, for instance, the American schools were, at least until recently. This provides him with a comfortable feeling of familiarity and he is not inclined to question certain British tenets until his involvement progresses and he becomes aware of the comparative lack of attention paid by British schools to some of the fundamentals of continental psychopathology.

Persistent discrepancy in international diagnostic practice since 1970

“…There was, in .iact, agreement about diagnostic labelling in only 16.7 % of cases of anxiety and 56 % of cases of depression. Moreover, the nontheoretical statistical approach which characterizes these diagnostic systems, disregards fundamentals of psychopathology and leads to dissolution of disease entities and syndromes (18,19). It seems therefore particularly important to preserve the ICD 8 with its clear concepts for international official use.…”

Use and Misuse of the PSE

“…Not one of them, however, can teach me how to recognise it; therefore it is omitted. Berner and KUfferle (1982) may be right to suppose that British psychiatrists ‘¿ rely too heavily on symptoms which are easy to define', but British empiricism suggests that symptoms which cannot easily be defined cannot easily be discussed, or recognised by anyone other than the originators. Their significance, therefore, cannot easily be tested.…”

“…However, I should like to consider some of the constructive ideas that have been put forward in three recent papers by authors steeped in the traditions of German-speaking psychiatrists (Berner and KUfferle, 1982;Koehler, 1979;Schmid, Bronisch and von Zerssen, 1982). All are in English, addressed to Anglo American clinicians, and use the PSE as one of the focal points for their analysis.…”

“…I could have selected many similar papers from British or American sources, and perhaps they may be the subject of another article, but the three I have chosen are fairly representative in that they illuminate several of the basic problems involved in trying to increase the advantages of a set of procedures, such as the PSE system, without, at the same time, increasing the disadvantages as well. Berner and KUfferle (1982), for example, suggest that it would be useful to regard the PSE symptom of ‘¿ hypochondriasis' as a fear of illness, to be included in the section on phobias. This is a valuable phenomenological suggestion and, in a draft for an eventual tenth editon, fear of illness wi!!…”

Whatever Happened to Delusional Perception?

“…Later on many scholars have emphasized the unreliability of the firstrank Schneiderian symptoms (FRS) [3][4][5][6][7][8][9]. Berner and Küfferle [10] have summarized this criticism by speaking of the myth of FRS. Delusional perception, thought broadcasting, thought withdrawal, thought insertion and feelings of alien influence, all considered to be at the heart of schizophrenic symptomatology in traditional German psychopathology as well providing as a firm basis for diagnosis, have met the same fate.…”