Is psychiatry only neurology? Or only abnormal psychology? Déjà vu after 100 years

Abstract

Forgetting history, which frequently repeats itself, is a mistake. In General Psychopathology, Jaspers criticised early 20th century psychiatrists, including those who thought psychiatry was only neurology (Wernicke) or only abnormal psychology (Freud), or who did not see the limitations of the medical model in psychiatry (Kraepelin). Jaspers proposed that some psychiatric disorders follow the medical model (Group I), while others are variations of normality (Group III), or comprise schizophrenia and severe mood disorders (Group II). In the early 21st century, the players’ names have changed but the game remains the same. The US NIMH is reprising both Wernicke’s brain mythology and Kraepelin’s marketing promises. The neo-Kraepelinian revolution started at Washington University, became pre-eminent through the DSM-III developed by Spitzer, but reached a dead end with the DSM-5. McHugh, who described four perspectives in psychiatry, is the leading contemporary representative of the Jaspersian diagnostic approach. Other neo-Jaspersians are: Berrios, Wiggins and Schwartz, Ghaemi, Stanghellini, Parnas and Sass. Can psychiatry learn from its mistakes? The current psychiatric language, organised at its three levels, symptoms, syndromes, and disorders, was developed in the 19th century but is obsolete for the 21st century. Scientific advances in Jaspers’ Group III disorders require collaborating with researchers in the social and psychological sciences. Jaspers’ Group II disorders, redefined by the author as schizophrenia, catatonic syndromes, and severe mood disorders, are the core of psychiatry. Scientific advancement in them is not easy because we are not sure how to delineate between and within them correctly.

From the Serotonin Model of Suicide to a Mental Pain Model of Suicide

“…13%). If these figures are correct, it is hard to defend the concept that biological variables are important in US completed suicides when it is not even clear that substance-related disorders or personality disorders are disorders in the medical sense [73]. …”

“…Jaspers [36], many years after leaving psychiatry, insisted that psychiatrists ‘must learn to think' [73]. Feinstein [25,27,75] designed ‘clinimetrics' [74,76] to deal with complex medical concepts, such as SB.…”

Phenomenological psychopathology in contemporary psychiatry: interfaces and perspectives

“…In the same vein, the epistemological project of the Diagnostic and Statistical Manual (DSM) has been the object of reticence regarding many points (Cosgrove & Krimsky, 2012;Stanghellini & Aragona, 2016). The range of fragilities of neopositivism is varied and encompasses problems of specificity, reliability, conceptual heterogeneity, excessive presence of comorbidities and tautologies (de Leon, 2015;Aragona, 2009). "Unintentional" effects have been recognized by their own support base (Andreasen, 2007) and, in the DSM series, the fifth and latest (APA, 2013) came amid brand new controversies (Frances, 2013).…”

“…There is no psychiatry that can ignore at its birth a conceptual understanding of the forms of consciousness that will be characterized as mental pathology. And the detailed characterization of such forms of consciousness, which will be the basis of the different moments of the psychiatric act, is the raison d'être of psychopathology as a science (Pellegrina, 2006;de Leon, 2015). Unlike disease-oriented semiology, his research is directed at the person and the subjective and inter-subjective experience of mental illness (Monti & Stanghellini, 1996).…”

Reply to the Multifaceted Aspects of Suicide Behavior by Tondo

“…Regarding [g], Dr. Tondo immediately associates Jaspers with ‘descriptive psychopathology', which the editorial did not mention; rather, it stated that Jaspers encouraged psychiatrists to think. A quoted reference [10] provided a more extensive elaboration of the importance of reading about Jaspers's psychiatric nosological groups.…”