The Concept of Psychosis: Historical and Phenomenological Aspects

Abstract

The historical development of the concept of psychosis and its increasing differentiation from the neuroses up to the modern classification systems, Diagnostic and Statistical Manual of Mental Disorders and International Statistical Classification of Diseases, is initially presented. In portraying this development, the struggle surrounding the clinical relevance of concepts on the one hand and their reliability and validity on the other are reflected. Thus far, diagnostic reliability has primarily been improved by focusing on externally observable symptoms in connection with expression and behavior. The identification of disease-specific symptoms, however, is principally achieved through the differential description of subjective experience. How this experience is to be explored and assessed remains for the most part unclear. With reference to its founder Karl Jaspers, the phenomenological method is presented as the decisive instrument for the assessment of experience. It is shown that a return to the legacy of phenomenology and a reformulation of the long-standing question concerning the specific symptoms of the schizophrenic psychosis are currently in progress. The revival of historical knowledge and a focus on direct clinical phenomena continue to provide inspiration for further advancement in modern psychiatry.

Ego Disturbances in the Sense of Kurt Schneider: Historical and Phenomenological Aspects

“…Compared with nonpsychotic symptoms and cyclothymia, first-rank symptoms were decisive in terms of differential diagnostics. The particular significance of first-rank symptoms and their close etiological connection with the concept of somatic disease led to a clear distinction between psychosis and nonpsychosis [52]. A formal modification of experience was considered to be an indication of the biological etiology of the symptoms [53].…”

The Moving History of Vestibular Stimulation as a Therapeutic Intervention

“…Only in the late 19 th hundred did Emil Kraepelin define 'dementia praecox' more closely, and shortly thereafter, in the early 20 th century, Eugen Bleuler introduced the term 'schizophrenia'. Before this introduction, schizophrenic symptoms may have been classed under more general concepts like 'madness' or even just 'insanity' (Bürgy, 2008;Heinrichs, 2003). This makes it difficult to trace the use of therapeutic vestibular stimulation in patients with schizophrenia through time.…”

The Origin of the Concept of Psychosis: Canstatt 1841

“…The concept of psychopathy was subsequently restrict-ed to personality disorders by Koch, Schneider and the DSM classification system. Since DSM-III, the increasing significance of descriptive criteria has led to an abandonment of the etiologically imbued concepts of 'neurosis' and 'psychosis' [14] . The limits of this development within psychopathology are increasingly being reached and DSM-V intends to re-introduce etiological criteria [15] .…”