Yehuda Fried

The Rise of Scientific Psychotherapy

Without going again into general considerations, we now try to present our view of scientific hypotheses as intermediary hypotheses — intermediary between general facts and metaphysics frameworks: the scientific hypotheses ideally explain general facts and conform to adopted metaphysics. And they should be empirically testable. For example, Newtonian hypotheses should all conform to Newton’s framework of forces acting at a distance within Euclidean space along a universal time scale; and they should explain all the known general facts of the physical world. The frameworks in medicine are, as we repeatedly say, generalist holism and externalist mechanism. The trouble with scientific medicine, we contend, is in the paucity of its explanatory hypotheses — regardless of their conforming or not conforming to either frame.

Contemporary Schools of Psychopathology

What is psychopathology? Etymologically the answer is quite simple. It means: the science of the suffering of the mind. But if one goes further from the mere translation of the word, then things immediately become complex and some elaboration on the subject is indeed required

Trends in 20th Century Psychotherapy

Let us declare this at once. In our view, nobody did so much for psychiatry as did Sigmund Freud. If we may speak for ourselves, though we do not mean to distinguish ourselves from other commentators, but rather in order to specify as our own responsibility as authors, we would say this. However strange it may sound, those of us who consider Pinel, Tuke and Rush to be the true and significant founders of psychiatry can appreciate Freud’s contribution all the more. It was they who returned to their patients their human dignity, yet they did so only in principle, whereas Freud has managed to employ their humane attitude in the service of his patients. They created this very branch — psychiatry — as a branch of medicine; yet those of us who sympathize with their humanism may well find that today they sympathise more with the challenges of modern antipsychiatry than with any other aspect of the profession. In such a frame of mind, throwing a detached glance at Freud, we can hardly fail to come up with a strong appreciation of the spirit of psychoanalysis coupled with a strong criticism of different aspects of psychoanalysis, not to say even very strong criticism of it.

Generalism vs. Externalism: The Concept of Disease

Every profession has an inner opposition from time to time, yet the opposition psychiatry has recently met is more than a mere expression of some inner dissatisfaction. This new movement has gained popularity outside professional circles, where it is known, somewhat inadequately, as antipsychiatry. Inadequately, because antipsychiatry is not opposed to psychiatry in general, but rather, at least according to one of the key claims of antipsychiatry, it is opposed to the Establishment of psychiatry or, if you will, to the vices of psychiatry. The chief vices of psychiatry, say its opponents from within, is the fact that it is built upon a general medical model. This model, the complaint continues, is employed in traditional psychopathology as much as in traditional physical medicine; yet in psychiatry it is entirely useless. The mere words — ‘the medical model’ — provoke endless anger and uncontrolled rage in some antipsychiatric circles.

Conclusion Towards a General Demarcation of Psychopathology

We wish to close this study with a theory which demarcates1 neurosis from psychosis. We are not speaking now of clinical diagnosis but of a general psychopathology.

Paranoia as a Fixation of an Abstract System

We begin with the classic observations of the development of logical thinking from childhood to adolescence due to Barbel Inhelder and Jean Piaget.1 We focus on the growth of the individual’s ability to consider alternative answers to a given question simultaneously and then test them. We also take for granted for a moment that this is scientific method as described by members of the hypothetico-deductivist school in the philosophy of sciences, especially Sir Karl Popper. Now B. Inhelder and J. Piaget have observed that children perform with varying degrees of success given tasks illustrative of the ability to employ scientific method. Infants think only about one alternative, and one which we can view as the concrete one; adults employ scientific method in ordinary circumstances naturally and with no difficulty, except that when alternatives multiply patience may run out. This gives the false impression that all we need to become scientists is more patience. In fact, however, science deals not with ordinary circumstances but with most unusual facts whose explanations require strong imagination and strong deductive powers.

The Paradoxes of Paranoia Revisited

We begin by considering the paradoxical axiom, which is the most widely accepted, by the profession and others, that the paranoic is in need of help though he suffers from an intellectual quirk. We can present the paradox of paranoia at once as the very well-known fact that we may observe two people with similar or seemingly similar intellectual structures (or thought-patterns, or practical logic, or what have you), one fairly independent and the other in dire need of help. Or we can present the paradox of paranoia at once as the very well-known fact that a paranoic needs help even though he may be, and often is, more intelligent, more perceptive, and more self-aware, than an average normal member of the community who can manage much more independently.

Introduction: The Paradoxes of Paranoia

Paranoia1, delire systematise chronique, is a well-known yet rare disease.2 Almost all jokes about madmen and all stories about mad scientists are about paranoics, yet they are very rare: Kraepelin, for example, saw only 19 of them in the whole of his career.3 The textbook tells us that the symptoms and signs of paranoia indicate the existence of a systematic localised chronic delusion, logically sustained. We shall elaborate on this definition later. Our immediate response to this definition, however, we would like to offer here: on the one hand, obviously, the definition is quite problematic; on the other hand, the definition has remained in the whole tradition unchallenged. Also, it is well-known, some paranoics arc hospitalized, some not. It is customary to add the view of paranoia as covering some serious emotional trouble, but this is done as an afterthought, and without clarifying what the emotional trouble is.4 To conclude, persecutory delusions and illusions of grandeur, are neither necessary nor sufficient for paranoia — quite contrary to commonly held views. For our part, we shall abide by all these points throughout the present essay: we shall accept the definition, its problematic character, etc. What we hope to do is only to expose the problems and try to cope with them.