Giovanni Stanghellini

The meanings of psychopathology

Purpose of review The scope of the present review is to criticize the trivial meanings of ‘psychopathology’ and re-examine its technical meanings and the role that psychopathology as the discipline that studies abnormal mental phenomena can play in todays clinical practice and research, and in the conceptualization of mental disorders. Recent findings I will first describe and discuss the way the term ‘psychopathology’ is mainly used in current psychiatric literature. This meaning, I will argue, is trivial. Then, I will move on to its technical meanings, including three classic sub-areas: descriptive, clinical and structural psychopathology, stemming from the studies of Karl Jaspers, Kurt Schneider and the phenomenological movement in psychiatry. Summary I will address the meanings of the term ‘psychopathology’ in current literature and contrast it with its meanings in continental 20th century tradition. The relevance of the discipline of psychopathology for psychiatry is three-fold: it is the common language that allows psychiatrists to understand each other; it is the basis for diagnosis and classification; it makes an indispensable contribution to understanding the patients personal experiences.

Alexithymia and Schizophrenias

The purpose of this study is to verify whether an increasing degree of alexithymia correlates with a prevalence of negative over positive symptoms. The framework of the research is phenomenologically oriented conception of the illness-coping vulnerability paradigm. Schizophrenic basic symptoms as markers of schizotropic process activity were assessed with the Frankfurter Beschwerde-Fragebogen, and cognitive features of the personological matrix were investigated using the Toronto Alexithymia Scale. Our findings on a sample of 20 longitudinally followed outpatients advocate the hypothesis that among those factors characterizing the tendency towards the nonparanoid prototype of schizophrenia, impairment of language capacity and alexithymia may have a relevant role.

Psychopathology: An edgeless razor?

The declining value of schneiderian first-rank symptoms (FRS) in differentiating between the two major functional psychoses has raised questions as to the utility of psychopathological concepts. In current diagnostic systems such as DSMs, psychopathological criteria and chiefly schneiderian symptoms have been used for nosographical purposes. It must be clear that this nosographically oriented use of psychopathology is only one aspect of the psychopathological enterprise. Indeed, while clinical psychopathology is essentially aimed at the identification of symptoms that are significant in view of nosographical distinctions, the specificendeavor of general psychopathology might be conceived as the organization of internal experiences around a core of meaningfulness, regardless of nosographical attributions. We seek to legitimate the value of psychopathological investigation and concepts as independent from any nosographical concern, and propose the concept of psychopathological organizers as synthesizing schemes of comprehension aimed at connecting different pathological experiences into unitary cores of meaningfulness.

Auditory Verbal Hallucinations – Breaking the Silence of Inner Dialogue

Auditory verbal hallucinations (AVHs) are usually defined as perceptions of speech that occur in the absence of any appropriate external stimulus. This definition, we argue, is false. We maintain that AVHs are disorders of self-consciousness that are best understood as the becoming conscious of inner dialogue. Normally, subconscious interior conversations are experienced as a sense of partnership between distinct parts: we feel these parts as distinct, but also integrated and collaborating with each other in decision-making and in self-representation. AVHs attest to a breakdown in this process of interior conversation: the feeling of unity in duality falls apart, and the dialectic partnership on which self-representation is grounded shatters into a mere dichotomy. There is a fracture in self-consciousness. If ipseity (i.e. the prereflective modality of self-awareness, the self-feeling of one’s own self in which the one who feels and what is felt is but one thing) is lacking, the sense of unity weakens, and the sense of duality increases. This crisis of ipseity is accompanied by an increase of reflexivity (i.e. the process through which I take a part of myself as a focal object of awareness). Hyperreflexivity contributes to the objectification of the sense of duality and to the loss of the sense of ‘myness’ of inner speech. In schizophrenics, inner dialogue becomes anomalously manifest. Whereas in normal conditions, inner dialogue is the medium for self-representation, AVHs arise through its morbid objectification: inner speech comes to the foreground in the concrete fashion of alien ‘voices’.

For an Anthropology of Vulnerability

The purpose of this paper is to revise the vulnerability model in the light of continental phenomenological psychopathology. Its main shortcomings, i.e. an insufficient assessment of basic phenomena and a blurred theory of subjectivity, are pointed out and improved by integrating the vulnerability model with the basic-symptom and intentionality theories. A clarification of the core property of schizophrenic basic phenomena--i.e., the loss of natural common sense--is achieved by means of the phenomenological methods of cognition. An analysis of the characteristics of major psychoses in terms of an excessive proneness (schizophrenia) or excessive resistance (manic-depressive illness) to the loss of natural common sense is carried out. This leads to an anthropological definition of psychoses as impairments of the dialectical movement between suspending common sense and conforming to it. The authors opinion is that these achievements of the continental phenomenological psychopathology can find a pragmatic reference frame in the vulnerability model, suitable for the therapeutical intervention and empirical research strategies.

Identity and Eating Disorders (IDEA): A Questionnaire Evaluating Identity and Embodiment in Eating Disorder Patients

Background: In this paper we tested the hypothesis that persons with eating disorders (EDs) are affected by disturbances of the way they experience their own body (embodiment) and shape their personal identity, assuming that the various kinds of anomalies of eating behavior are consequences thereof. Sampling and Methods: We developed and validated a new self-reported questionnaire named IDEA (IDentity and EAting disorders), which was administered to 147 ED patients and 187 healthy controls. Test-retest reliability, internal consistency, psychopathological correlates, and concurrent validity were evaluated. A factor analysis was performed to verify the distribution of items into subscales. Results: The questionnaire showed good test-retest reliability, and internal consistency. IDEA scores were specifically associated with ED psychopathology, and they did not show any correlation with sociodemographic and general clinical variables. Four factors were extracted, which were related to the following phenomena: ‘feeling oneself only through the gaze of the other and defining oneself only through the evaluation of the other’, ‘feeling oneself only through objective measures’, ‘feeling extraneous from one’s own body’, and ‘feeling oneself through starvation’. Conclusions: IDEA represents a multidimensional, brief, versatile, easy-to-perform instrument for clinical evaluation, assessing abnormalities in lived corporeality, and of personal identity, which appeared to be specifically associated with the core features of ED psychopathology. The main limitations of the study are the cross-sectional design. Also, it is impossible to ascertain whether the domains we assessed are specific traits of patients with EDs, or state-related features. To answer this question, a longitudinal study is needed.

Basic symptoms and negative symptoms in the light of language impairment

The Frankfurter Beschwerde-Fragebogen (FBF), assessing basic symptoms (B-S), and the Scale for the Assessment of Negative Symptoms (SANS) were administered to 30 patients satisfying DSM-III-R criteria for the diagnosis of schizophrenia. Considering the relationship between BS and negative symptoms (N-S), we identified the key role of the impairment of receptive and expressive language for the correlation of these two orders of phenomena.

Dysphoria, vulnerability and identity. An eulogy for anger.

Compared with the bulk of psychiatric literature dedicated to sadness or euphoria, dysphoric states have received relatively little attention. Perhaps we find ourselves facing a removal of anger from the horizon of contemporary psychopathology. Even less attention is given to the ‘doublets’ of anger. Anger marks off a region of the psyche within which the game of identity is played: as indignation, it defends the limits of that which is tolerable, the border upon which to keep watch, the trench from which to fight. But as fury, in the excess of the absolute affirmation of one’s own existence, it incarnates the wreckage and the bloody fall of identity – i.e. pathology. The topic then collects the interweaving of the subjectivising character of rage on the one side, and on the other the explosive one, which breaks up the unifying and conciliatory direction which rationality enforces upon the subject – ‘anger of life’ and ‘anger of death’. Both dimensions are explored with special concern to the reason for empathising with anger.

Phenomenological Questions about Obsession and Delusion

The problem of the relationship between obsession and delusion is dealt with from descriptive, anthropoanalytical and purely phenomenological points of view. The main differential aspects are focused. The phenomenological concept of the progressive fading of the feeling of Ego activity is proposed as the functional bias at the basis of the continuum linking obsessive symbolic awareness to delusional perception.

Psychopathological roots of early schizophrenia: adolescent vulnerability, hebephrenia and heboidophrenia

Purpose of review This paper focuses on socio-emotional problems in early schizophrenia. According to recent empirical studies, difficulties in interpersonal relationships during childhood and adolescence are the strongest predictors of schizophrenia. This finding is traced back to its historical antecedents. By reconsidering the works of those psychopathologists, like Hecker, Kahlbaum and Kretschmer, who first worked out the idea that schizophrenia develops out of the vulnerable condition that is immanent in adolescence, the nature of social, emotional and interpersonal abnormalities is clarified. Recent findings Building on recent empirical studies, a hypothetical identikit of at-risk adolescents is sketched, including five main psychopathological dimensions: difficulties in interpersonal relations, abnormal emotional contact, self-disorders, neurodevelopmental disorders, and neuropsychological disorders. Research supporting this identikit is reviewed. Summary Matching recent empirical studies with early descriptions, the hypothesis that an adolescent having persistent difficulties in managing the emotional side of interpersonal relationships is a candidate for schizophrenia is discussed. The aim is to shed new light on the controversial concept of social and emotional dysfunction.