Phenomenology of affective disorders Flashcards
What did Edmund Husserl describe?
The phenomenological method of pure observation and introspection
What did Karl Jaspers write?
- the first book on applying the phenomenological method of psychopathology (Hi Matt! you wrote here “introduction to phenomenological” but I think the book is “General Psychopathology”)
- He suggested clinicians don’t have the time to think regarding their projects and rather “amass facts blindly” - objectives are stifling the opportunity to think
Who developed a group of qualitative methods for phenomenology in psychology?
Amedeo Giorgi - led the American movement and guided by Husseri and Merleau-Ponty
- Qualitative psychology uses the same philosophical principles
- Giorgi employed phenomenological assumptions and incorporated qualitative methods into experiments
How does Karl Jaspers describe what phenomenology is?
Approach to assessment which uses a concrete description of psychic states
Presents them for observation and reviews their inter-relation - defining them distinctly and creating appropriate terminology
For this empathy is required to understand the patients experience (as we can’t perceive their experiences on our own)
We can use the patients own self-descriptions in this as a window into their world
Name some principles Jaspers describes into how to conduct a phenomenological approach to psychopathology
For phenomenology we need to ask what is really happening in our patients, how do they feel, what are they going through
TO do this accurately
- Do not start with links to the patients whole experience
- Do not try to link to theory or speculation
- Use descriptions of what are going on in the patients consciousness
- Focus attention to what exists before - what we can understand, discriminate and describe
- Its important to be open - don’t prejudge the observation = it requires practice and critical analysis - to have a phenomenological approach is an onslaught to our prejudices
- Stick to what we observe
In general psychopatholgoy how does Jaspers focus on different elements in parts I, II and III
In Part I:
- Focus on individual psychic phenomena which we describe as they are without linking
- -> Subjectively experiences that are vividly represented (phenomenology)
- -> Objective experiences i.e behaviour, appearances, somatic symptoms
Part II and III:
- What do we know how these psychic experiences are represented
- We assume theoretical distinction in subjective and objective psychopathology
- -> using empathy we understand how one experience can occur from another
- ->From repeated observations we can know how many phenomena are regular linked and therefore can explain causal mechanisms
What is nosology?
Synthesis of disease entities
Jaspers viewed this as preliminary and that phenomena aren’t rigid structures rather we can feel nuances in them > a precise formulation
He proposed if phenomena were rigid then disease may be like mosaic-like-structures with generally identical pieces and which phenomena (fragment) appeared most frequently would be the diagnosis
–> Jaspers felt this was superficial and turns psychopathological investigation into a mechanical process that stops discovery
- However this is needed to a degree to ensure inter-rater reliability
How does Jaspers describe different causal approaches to mental illness in general psychopathology
History of disease entities:
- Disease entities are formed from certain symptom clusters e.g. melancholia, furor, confusion, dementia
- These represent attempts to form a basic psychological structure for mental illness
- -> Meynert - amentia is lack of associations (incoherence)
- -> Wernicke - brought Meynert further but failed to form psychological structure
- -> Bleuler - theory of schizophrenia
“More natural” structural unit
- Mental illnesses with similar causes should be grouped
- Morel and Magnan (French) proposed - theory of disposition and heredity –> many psychoses fall int the category of hereditary mental illness - illness of degeneration –> one degenerates into madness
“Anatomical causes”
- Cerebral processes form a disease entity
- At this time they believed general paralysis (Syphillis) is in the same paradigm as mental disorders
- This discovery was the paradigm for how psychiatry should work
How did Jaspers adapt Kraepelins triadic system?
Somatic causation - was defined as a criteria for causing mental illness (certain psychoses were thought to be endogenous and have an unknown somatic cause - namely manic-depressive illness and schizophrenia)
Kraepelin may have had a dualistic approach to mental illness (brain is part of body / mind is part of the psyche)
- This may have led to the somatic causation criterion as the main etiological criterion
Why may Jaspers have backed a triadic system for mental illness at the time?
At the time there was a lack of evidence of heritability of abnormal personalities and neuroses > endogenous psychoses
- However we now know this is not necessarily the case and what was thought as normal variation in personality may be genetically/biologically caused
- However somatic causation has failed to distinguish the psychiatric disorders currently
What is Kraepelin’s layer rule?
Hierarchy of causes
- Organic causes
- Endogenous causes (includes mood or schizophrenia)
- Related to psychosocial (anxiety/adjustment disorders)
–> Not made explicit in ICD10 or DSM-V however he hierarchical superiority does exist (i.e. anxiety symptoms/substance use disorder from bipolar or schizophrenia)
Describe some problems with the layer rule/triadic disorders?
Organic
- Lack of definition for organic disorders - what is threshold for a strong cause between biological disease and psychopathology
Endogenous
- How much psychosocial factors are allowed in endogenous disorders - how pronounced are the biological abnormalities?
Maybe consider overlap between the three areas - ven diagram with MDD placed between endogenous disorders and adjustment disorders
What is the present state examination?
Tool to assess symptoms using the phenomenological tradition - devised by John Wing
“Measurement and classification of psychiatric symptoms”
Uses operationalisation and quantification to improve inter-rater reliability
How does the PSE help to clarify misinterpretation, misidentification or delusion of reference?
Ensures there is a real perception and delusional misinterpretation
- i.e. subject may in real life see interviewer cross legs
- Delusional misinterpretation would be that they are doing this as they think I am homosexual +/- doing it specifically to provoke me
Provides questions to follow up to gain a good understanding of symptom
- Are you being tested?
- Have you seen you referred to on TV/media
- Do you think people are provoking you?
What is the WHO alternative to PSE?
Schedule for Clinical Assessment in Neuropsychiatriy (SCAN)
- Tested in field trials across the world
- Has transcultural reliability
