Le projet de la psychiatrie phénoménologique

Phenomenology has without doubt played a highly significant role in psychiatry, psychotherapy and psychoanalysis. Even today, a large number of professionals in these sectors still find a source of inspiration in the works of Husserl, Minkowski, Jaspers, Heidegger, Szilasi, Boss and Binswanger. In the present study, the author has sought to explain precisely what phenomenological psychiatry encompasses - referring in particular to the work of Ludwig Binswanger. However, the reader is first required to follow the author's examination and reconstruction of what is meant by phenomenology.     

Psychanalyse et phénoménologie

Psychoanalysis and phenomenology are complementary and share common objectives of care. However, they differ regarding their methodology. The status of Unconscious, Interpretation and Dream are different in psychoanalysis and Daseinsanalysis. We focus on the central role Daseinsanalysis got for explicating psychoanalytical experience. In Binswanger's work, love is understood as an existential dimension, complementary of Heidegger's Anxiety. This concept is useful for explicating how actually does work psychoanalysis.     

Vécus corporels et psychiques : phénoménologie d’une unité

To be able to give up thinking about how consciousness could be naturalized means that neuroscientifics could make place not only to subjectivity, but more over to physical experiences such as emotions, affects, how they are felt, how they become history, how they come back.The phenomenological comprehension of the links between the physical and the psychical part of ourselves, the phenomenological comprehension of our psychosomatic unity helps the materialist explanations about the organism functions (brain included) to discover what the self means; whereas psychopathology has now to make up with the perceiving body experiences, a corporal subjectivity.If such an evolution could allow some kind of a dialog between these complementary knowledges, any pain and illness would have to be seen as both psychic and physical.     

Psychoéducation et attitude phénoménologique en psychothérapie de groupe

Objectives

Psychoeducation contains the risk of a misunderstanding in the effective experiences of recognition. We want to show that group psychotherapy can be a means to reconcile recommendations in disease prevention aimed by psychoeducative measures, the vivid and lively dimension of experience found in phenomenological attitudes and aspects, turned to the community world of therapeutic mediation.

Method

To articulate these various domains, we approach the principles of psychoeducation, the risks which this one can contain and the contributions of clinical phenomenology. Phenomenological method is different from what we call collectively clinical intuition which is always implicitly colored by the typical contexts of meanings of what appears (meanings which have a practical and effective reach for example) and stay, in spite of the critical distance which we can put it, stuffed with various emotional and theoretical predicates muddled between them. The phenomenological attitude aims as much as possible to a suspension of these predicates, that these predicates arise from the common sense of everyday life or that they arise from a detailed specialized knowledge, and this to remove the “coats of sense” which settled on the perception.

Results

The group, by its multiple interactions, aims at an optimization of the articulation of the self-relationship with relationship socially adapted to the others. The therapist constantly has to attend to dialectical dynamics which reigns between a certain self-dissolution in the group and a return to oneself from the meshing which build up itself within the group. For certain patients, it is particularly difficult to maintain a just balance between the two moments of identity, the one which is peculiar to oneself and the one which emanates from relations with the others towards which we are normally constantly turned. The interest of this psychotherapeutic work in group is here to offer to each of participants the possibility of holding, with a little more confindence, an existential position within a meshing of social links, that is a capacity to seize oneself as existing among the other beings having themselves an own existence. From there, the subjective capacities of each can be better recognized, what can also give place to adjustment of these capacities with individual aspirations. The active implication of patients, so looked for by psychoeducation, is all the more tangible as we were so able to appeal, by the phenomenological attitude, to what feels immediately and without distance as much in an intimate self-relation as in relationship to the others.

Conclusions

Phenomenological attitude allows not to get stuck in imaginary expert skills, in rational projects of organization and other methodical constructions of the science. This attitude is particularly interesting for group psychotherapy which privileges the opening rather than a work of elaboration. The stake is so the authenticity of a real therapeutic alliance based on fine regulations of the global situation of co-presence taking into account the interlacing of the implicit and the explicit in the exchanges which weave with the patients. We privilege a fertile step rather than rigorous observance of a method which would lead only to a systematization against the spirit of phenomenology. The clinical experience shows that this psychotherapeutic method allows in particular a regular attendance of the group, what is one of major ingredients of its efficiency.     

Analyse phénoménologique de la notion d'événement et ses implications pour la psychopathologie

If, contrary to most facts whose meaning is context dependant, an event is understood as having a meaning that is not context dependant, precisely because this event reshapes completely the context, one can understand that such an event may induce the collapse of all basis of interpretation, or in other words the collapse of the world as the horizon of intelligibility, as the horizon of possibilities from which can be constructed the meaning. One can also understand in which sense the world we deal with, when such an event occurs, is the world that arises with and through this event. This phenomenological understanding of the event sheds a new light on aspects of empirical research in psychopathology in which the event plays a central role. We will consider the case of “reaction pathologies”, as well as epidemiological research on life events in psychopathology. Finally, we will come back to the hypothesis, proposed by philosophers, of a loss of the ability in psychotic states to remain open to the event, and in general to the unforeseen..     

Le rapport du sujet au langage : vers une approche des « phénomènes de style » dans la clinique des névroses

The present article questions a paradox specific to the clinical approach: how to reconcile the advantage in identifying structural indicators enabling a diagnostic to be elaborated, while also deriving the consequences of the limits of the structuralist hypothesis in order to aim at the indeterminate? Exploring the link between language, clinical structure and subjective position affords a way of highlight the structuring function of language in so far as it separates the body from its pleasure, thus simultaneously bringing out the subject. However, this link also reveals the antinomy between the universal and the singular, for which the notion of “style” constitutes an issue to be situated at the very core of the constitution of the subject and the social link. In its very prolongation, the notion of “phenomenon of style” emerges on the horizon as a possible specificity of the neurotic subject's relation to language. Indeed, J. Lacan showed us a tension at the origin of style: this both involve an effect of structural determinations, and that of a subjective choice in ethical terms. J. Lacan first explored the question of style in order to elucidate psychosis phenomena, but it also concerns, though not directly, neurosis. Through this approach, we hope to address the enigma that is constitutive of the subject in inventing its own neurosis, while simultaneously considering the traces of the movement that pushes a subject to invent words to express the unspeakable.     

L’œuvre d’Henri Ey et les évolutions de la phénoménologie

Henri Ey left a work which still helps in the comprehension of current mental disorders, of psychopathology and of psychiatry in our society. Its conception is rooted in phenomenological philosophy side by side with clinical, anthropological, medical and sociological references. We will study three paramount fields: the integration of Husserl's topics by Henri Ey via the method of phenomenology; the constitution of transcendental conscience; and that of psychological conscience. The elementary dynamics of psychic life concern the elaboration of perception and of representation. Henri Ey and Husserl both take into account the cognitive and emotional dimensions of these fields in the very elaboration of the unconscious. Finally, we will locate Henri Ey's frequent references to Max Scheler in his studies on anguish and mood disorders. Phenomenology is for Henri Ey the fundamental base of his integrating conception.     

Eugène Minkowski, aux sources de la psychopathologie phénoménologique

E. Minkowski (1885-1972) played a great part at the beginnings of the phenomenological psychiatry and gave this new trend the opportunity to reach France in the early 1920's. Its works, based on Bergson's philosophy and a careful clinical observation, have a very individual tone, but remain faithful to the phenomenological approach. For him, psychopathology is the psychology of pathology and not the pathology of psychology.     

Un modèle de conscience de soi suggéré par la psychosociologie de l'invention

Knowledge in the making can be regarded as a relational system. Through concepts and apparatus linked to them, the scientist build a relation with nature that fits with the idea she has about it. This model can be applied to consciousness in general, apart from that form of consciousness induced by scientific knowledge. Like scientists, our consciousness is built through a fusion-differentiation process from other people leading to the building of culture as an ethnotheory. This process leads to a “consciousness in action” depending from the success or the failure of expected roles and real behaviors of nature and the energetic balance of these cycles. This model fits with a specific contemporary psychotherapy. It leads to phenomenology and anthropological psychiatry.     

Une phénoménologie de la dépendance à l'alcool. Une expérience primordiale de la « nostrité »

The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”.     

Phénoménologie non intentionnelle et psychopathologie

The relations between phenomenology and psychopathology must be examined in an evolutionary perspective. Two distinct periods clearly stand out this way: a founding period and a contemporary period. The former period encompasses the works of E. Husserl, M. Heidegger and L. Binswanger. As for the contemporary period, it is characterized by a close connection and a convergence between the works of many phenomenologist psychiatrists and philosophers. This presentation will focus on the contemporary period and will aim at bringing to the fore a new trend in the relations between phenomenology and psychopathology, characterized by a closer, and thus more complex, reciprocity. Indeed, contemporary phenomenology takes into account and integrates the understanding of psychotic phenomena as far as to transform the sense of philosophy; it looks as if there were a break with the intentional phenomenology. According to Husserl, the consciousness is always consciousness of something, intentionality is a property of directedness towards an object. Not only do psychotic phenomena question the organisation of thinking, but also the constituent forms of experience, rooted in non intentional grounds. Three philosophers, Henri Maldiney, Marc Richir and Michel Henry, have renewed the non intentional approach of phenomenology. Recentering itself on the enigma of madness, philosophy makes it possible for psychiatry to reconsider mental illnesses which used to be dealt with only in terms of deficiencies. The reference to H. Maldiney will shed light on the human phenomenon seen at the crossing of the catastrophe and of the crisis. The issue of philosophical anthropology is then posed on the background, which is questioned and destabilized by the psychotic experience seen as an agonistic moment of derealisation and depersonalisation. The schizophrenic existence evades any constituent foundation of subjectivity and intentionality. The presentation of M. Richir's meditations will then lead us to redefine philosophy as a radical phenomenological epoche confronted with the abyss of the psychotic epoche. M. Richir re-enacts the Husserlian tradition, and in particular, the idea of genetic phenomenology, dealing with passive syntheses in which the body-of-flesh and the non intentional tonality come before the emergence of the consciousness. The last reference will be the work of M. Henry bases on philosophy of life and non intentional phenomenology; an opposed direction to Husserl will be taken by singling out pathos as an auto-affection of life. Pathos becomes the essential form of affect as condition for the actual existence, independent of intentionality. According to M. Henry, life never appears in the exteriority of the world, life's pure manifestation appears in its invisible interiority. The end-point of this phenomenology is the primitive suffering, thus the phenomenology of life concerns the qualitative aspects of psychopathological experiences bounded to a radical passivity. From the issue of psychosis, contemporary non intentional phenomenology carries out the theoretical, therapeutic and ethical consequences in the field of psychiatric research and practice.     

Une approche de la phénoménologie de la dépression par l’Entretien Semi-structuré Multiregistres

Objective

Whereas instruments are available to diagnose depression and to rate its severity, there is a lack of instruments to assess the phenomenology of depression, i.e., a set of mental phenomena that compose subjective experience. The Algorithmically Structured Systematic Exploration of Subject's State of Mind (Assess_Mind) is based on open questions asked via a structured algorithm. The objective of the present study was to show how the Assess_Mind allows to investigate the depressive phenomenology in patients presenting a major depressive episode.

Patients and methods

Thirty-five patients presenting a major depressive episode were assessed with the Assess_Mind and with a battery of standardized instruments. After hospital admission, two Assess_Mind interviews separated by 24 hours were conducted, and a third interview took place 3 weeks later. Using vignettes drawn from the three interviews conducted in two patients, we illustrate the workings of the Assess_Mind and the clinical material that it reveals.

Results

The Assess_Mind provides a detailed and specific assessment of the patients’ phenomenology and of its course over time.

Conclusion

In major depressive episodes, the Assess_Mind should contribute to help clinicians to conduct the initial assessment and to follow the course of patients under treatment.     

Neurosciences et phénoménologie-II : sortir du bocal à mouches

In this second part, we suggest how phenomenology allows to disrupt the circularity of the scientific method. Then, we show how much this philosophy is compatible and coherent with the second cybernetics’ principles and an epistemology of complexity. At last, we will propose a neurophenomenology taking into account this second cybernetics and getting away the conventional paradigm of cognitive neurosciences.     

Y a-t-il une actualité clinique de Fanon ?

Who was Frantz Fanon? A political activist, a writer. But Fanon was also an important clinician. The article concerns the accent this aspect of its work and gives as objective to highlight the clinical part of the work of Fanon. His links to the institutional psychotherapy and also its papers on the war traumatism will be analyzed. And also will be envisaged the contradictory connectionsof Fanon to the psychoanalysis.     

Regard phénoménologique sur le noyau sensitif

In 1927, Ernst Kretschmer published the second German edition of “Paranoia and sensitivity: contribution to the problem of paranoia and psychiatric theory of character” in which Kretschmer opposes Kraepelin and abandons the idea of a persecutory delusion arising from an isolated point, evolving inexorably to the chronic state according to a rigid and progressive paranoid schema. In opposition to this implacable evolution, which for Kraepelin shows the progressive advance of an illness, Kretschmer posits the instabililty of the delusion and the frequent occurrence of an “abortive” paranoia: sensitive to the context, variable over time.Moreover, this author abandons the idea of identifying a single sensitive character, describing asthenic, psychopathic, expansive forms. He does nevertheless bring out an essential type of existence, seeking a common trait behind this clinical variability: retention of affects. This clinical approach is similar in some respects to the phenomenological approach: the reduction of any theory on paranoia and the free variation on the sensitive characters make it possible to go beyond the facticity of clinical pictures and to identify the eidetic characters of a paranoid type.We propose to identify other essential manifestations of such an existential type, and to envisage their relations with the melancholic type and the schizophrenic type. In particular we will examine the essential reasons for the sensitive's failure in meeting others, in reference to Buytendjik's phenomenology of meeting.     

La psychiatrie phénoménologique du XXI siècle ; psychosomatique et nosologie

Phenomenology, modus operandi of epistemological research in psychiatry is today rich of a great number of anthropological texts. Facing the XXIst century, it looks at its singular ability to criticize and to make links between natural sciences and human sciences so that it aims to raise the question of unity, while reconsidering the psychosomatic question, through a reaxamination of nosology.     

Phénoménologie et bases de l’évidence psychiatrique

The authors ask whether phenomenology may produce a kind of evidence liable to differ from that conveyed by the “Evidence-based medicine”. Following Heidegger's thought, they show how the latter is rooted in the Latin notion of evidentia revised by Descartes as scientific proof. The phenomenological notion of “evidence” seems to be closer to the Greek enargeia according to which the things themselves are asking how they want to be caught. Through this opposition, one may have an inkling of the limitations of current psychiatry.     

La relation thérapeutique sans le savoir. Approche anthropologique de la rencontre entre travailleurs pairs et personnes sans chez-soi ayant une co-occurrence psychiatrique

Data was gathered in the course of a one-year ethnographic study with a team of peer outreach workers, in the city of New Haven (U.S.A.). On the basis of this experience, we propose a phenomenological approach to the therapeutic relationship, by studying three types of relations linked to distinct roles (psychiatrist, anthropologist, peer worker) held when encountering persons who are homeless and ill. Because of the often-problematic interactions that homeless persons experience with institutions, the first problem faced in street work is to build a relationship of trust, which takes time and may be chaotic. Peer workers are familiar, from their personal experience, with the street context, the condition of homelessness and the experience of illness. This latter includes not only the fact of having been the object of psychiatric categorisation, but also the consequences; the interaction with institutions as a consumer; and especially the experience of an advanced process of recovery. Peer workers posses a unique skill that allows them to improve access to these persons. The question of the ideal therapeutic distance is revisited by these peers. To validate this experiential knowledge is to recognize both a unique form of cultural capital and health democracy.     

La subjectivité à l'épreuve du rêve. Une étude phénoménologique de l'intentionnalité et de l'affect

In this essay, the author analyses the concepts of intentionality and affect according to Husserl's phenomenology. She supports these two concepts, which are both ontological and psychological, with a thesis of subjectivity that also finds its roots in the work of Georges Lantéri-Laura. Dreams, as a phenomenon belonging to the sphere of nocturnal experience and to the sphere of narrative intentionality, represent for the author a cornerstone of a theory of subjectivity that integrates both the thesis of intentionality and of the unconscious. The author articulates her study of dreams through clinical and literary examples that enable one to grasp the spatio-temporal structures of the intentional conscience as well as the affective movements between the nocturnal world and narration of the following day.