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Tuesday, 28.09.2021

Carlos Morra and Mateo Kreiker: Psychopathology

 

6. Thomas A. Ban: Development of the language of psychiatry*

 

        It was Galen (131-201) who was first to recognize that “symptoms” follow disease as shadow its substance (Garrison 1929). Yet, development of “psychopathology,” the “language of psychiatry,” began only in the mid-19th century in the course of early attempts to differentiate sub-populations within “insanity.”

        The term psychopathology first appeared in the psychiatric literature in 1845 in Feuchtersleben’s textbook, the same book in which the term ”psychosis” was adopted; throughout the second half of the 19th century the term was used as a synonym for psychiatry.

        During the 19th century the vocabulary of psychopathology steadily grew. Esquirol (1838) divided false perceptions into “illusions” (distortion or misinterpretation of real perception) and hallucinations (perceptual experiences without corresponding stimuli in the environment); Griesinger (1845) distinguished between “pale (pseudo) hallucinations” (that appear in the inner subjective space and can be controlled voluntarily) and  “true (real) hallucinations” (usually referred to hallucinations” simply); Wernicke (1881) separated  “dysmnesia” (memory impairment) from “dementia”  (personality deterioration).

        Psychopathology became a discipline to provide a foundation for psychiatry in the early years of the 20th century. Instrumental to this development was Karl Jaspers’ (1910, 1913) observation that in different psychiatric diseases patients’ process (in their brain) and consequently perceive the same “content” (information) in different “forms.” His recognition of the relationship between the ”forms” in which information (“content”) is perceived by patients  and their  illness, led to the birth of “phenomenological psychopathology” (phenomenology), the branch of psychopathology that deals with “abnormal subjective experiences of individual psychic life.” It also led to his separation of “psychiatric disease process,” displayed by “abnormal forms of experiences,” from “abnormal personality development,” displayed by behavior that deviates from the statistical norm. 

        For the “phenomenologist,” it is not the subject matter, the information, (“content”) the patient talks about, but how (“form”) the patient talks, and it is not the “somatic (hypochondriacal) complaints” (“contents”), but the form, how these complaints are experienced as “bodily hallucinations” (somatic experiences without corresponding stimuli in the environment), “obsessive ideas” (ideas that persist against one’s will), “hypochondriacal delusions” (false beliefs based on a priori evidence) that is relevant to diagnosis (Fish 1967; Taylor 1981). Even in case of “delusions,” a “content disorder of thinking” that signals the presence of an ongoing psychiatric disease (“psychosis”), it is not the “content“ of the “delusions,”  such as “delusions of reference,” “delusions of love,” “delusions of persecution,” etc.,   but the “form” in which the “delusion” appears,  i.e., a “sudden delusional idea” (a delusional idea that appears to be fully formed),  a “delusional perception” (a delusional meaning  attributed to a normally perceived object),  that is relevant to the characteristic abnormality of the processing of signals by the  brain that differentiates one psychiatric disease (process) from another (Guy and Ban 1982;  Hamilton 1985).

        It was on the basis of  “phenomenological analyses” that Kurt Schneider (1920, 1950), distinguished between “vital depression,”  a disease, from the “other depressions,” and separated “personality disorders,” displayed in “abnormal variations of psychic life,” the subject matter of “abnormal psychology,” from “psychoses” (mental disorders), displayed in “abnormal forms of experiences,” the subject matter of “psychiatry.”

        During the years from 1918 to 1933 a group of psychiatrists that included Hans Gruhle and Wilhelm Mayer-Gross, in Kurt Wilmanns’ department of psychiatry at Heidelberg University in Germany, spearheaded “phenomenological analyses” in psychiatric patients (Shorter 2005). Their effort has yielded a vocabulary that includes distinct words (symptoms) from pathologies of “symbolization,” such as “condensation” (combining diverse ideas into one concept) and “onematopoesis” (building new phrases in which the usual language conventions are not observed), to pathologies of “psychomotility,” such as “ambitendency” (the presence of opposite tendencies to action) and “parakinesis” (qualitatively abnormal movements). In  “phenomenology,” “dysphoria,” the negative pole of “vital emotions,” is distinguished from “dysthymia,” the negative pole of mood,  “psychomotor retardation,” the experience of a spontaneous slowing down of motor activity, is distinguished from “psychomotor inhibition,” the experience of slowed down motor activity, etc.

        Furthermore, by linking the terms that identify the different abnormalities to psychiatric diagnoses in use at the time, e.g., “tangential thinking,” characterized by talking past and around the point, with the “schizophrenias,” “circumstantial thinking,” characterized by overbearing elaboration on insignificant details without losing track, with the “dementias” and “rumination,” characterized by endless repetition of unpleasant thoughts, with “depressions,” the Heidelberg group set the foundation of a language for psychiatry.

        The vocabulary of “psychopathology” that deals with cross-sectional features of disease, was extended to include the vocabulary of “psychiatric nosology” for describing psychiatric disease in its “dynamic totality” from “onset” through “course” to “outcome” (Ban 1987).

        The two disciplines, “psychopathology” and “psychiatric nosology,” are intrinsically linked: psychopathology deals with symptoms, i.e., abnormal subjective experiences (“phenomenology”) and signs, i.e., “objective performance changes” (“performance psychology”), whereas ”nosology” deals with the synthesis of “disease entities” from symptoms and signs, and classification of the  diseases  synthesized (Jaspers 1962). While classifications provide names (denominations) and descriptions of disease (qualifications), nosology provides the methodology “how” diseases and classification of diseases are derived (Ban 2000).

References:  

Ban TA. Prolegomenon to the clinical prerequisite: psychopharmacology and the classification of mental disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry 1987; 1:527 -80.

Ban TA. Academic psychiatry and the pharmaceutical industry. Progress in Neuro-Psychopharmacology & Biological Psychiatry 2006; 30:429-41.

Esquirol JED. Des maladies mentales Considerees sous les raports medical, hygienique  et medico-legal. Paris: JP Bailliere; 1838.

Feuchtersleben E. Lehrbuch der Ärztlichen Selenkunde. Vienna: Carl Gerold; 1845.

Fish F. Guide to Leonhard’s classification of chronic schizophrenias. Psychiatric Quarterly 1964; 38:438-50.

Fish F. The influence of the tranquilizers on the Leonhard schizophrenic syndromes. Encéphale 1964; 53:245-9. 

Fish F. Clinical Psychopathology. Bristol: John Wright & Sons; 1967.

Garrison FH. An Introduction to the History of Medicine. Philadelphia/London: WB Saunders; 1929.

Griesinger W. Die Pathologie und Therapie der PsychischenKrankheiten. Braunschweig: Wreden; 1845.

Guy W, Ban TA, edited and translated. The AMDP System. Manual for the Assessment and Documentation of Psychopathology. Berlin/Heidelberg: Springer; 1982.

Guy W, Ban TA, Wilson WH. An international survey of tardive dyskinesia. Prog Neuro-psychopharmacol & Biol Psychiatry 1985; 9:401-5.

Hamilton M, editor. Fish’s Clinical Psychopathology. Bristol: John Wright & Sons; 1985. Language Publishing House; 1954.

Jaspers K. Eifersuchtswahn: Entwicklung einer Persoenlichkeit oder Prozess. Zeitschrift für die gesamte Neurologie und Psychiatrie 1910; 1:567-637.

Jaspers K. Allgemeine Psychopathologie. Berlin/Heidelberg: Springer; 1913.

Jaspers K. General Psychopathology. (Translated from the 7th edition of the German original into English by Hoenig J and Hamilton MW).  Manchester: Manchester University Press; 1962.  

Schneider K. Die Schichtung des emitionalen Lebens und der Aufbau der Depressions zustände. Z Ges Neurol Psychiat 1920; 59: 81-5.

Schneider K. Klinische Psychopathologie. Stuttgart: Thieme; 1950.

Shorter E. A Historical Dictionary in Psychiatry. Oxford/New York: Oxford University Press; 2005.

Taylor MA. The Psychiatric Mental Status Examination. New York: Pergamon Press; 1981.

Wernicke C. Lehrbuch der Geisteskrankheiten für Aerzte und Studierende. Vol. 2. Berlin: Theodor Fischer Kassel; 1881-1883, pp  229-42.

 

*Extracted from Thomas A. Ban: Neuropsychopharmacology and the Forgotten Language of Psychiatry. inhn.org.ebooks. November 14, 2013.

 

August 20,  2020