Queen’s University
Department of Psychiatry
GRAND ROUNDS
Friday, October 18, 2013

Providence Care – Mental Health Service...
Learning Objectives
1. Jaspersian Echoes: Briefly survey Jaspers’s scholarly reception
in North American psychiatry.
2. Lo...
I. Jaspersian
Echoes
Jaspers’s Echoes in North America
Echoes- DSM & Death of Phenomenology
Echoes- DSM-IV,ICD as reified categories
“Antagonomia” &
“Idiomania”
Echoes- Perceptual Field Deficit
Echoes- Time Consciousness
Echoes- ‘Joint Reference’ Overcoming Biomedical Bias
Depressive Realism, the Cognitive Distortion Model
and Existential Psychotherapeutic Methods
Echoes- Diagnosis & Ideal Types
Echoes- Perspectivism & Methods
II. Looking
Back
General Psychopathology
The General Psychopathology
“Phenomenology” Defined (1912)
“….Illustrative representation of individual experience
(anschauliche Vergegenwärtigung ind...
Tasks of “Phenomenology” (1913)
Provide concrete descriptions of
individual psychic states and present
them for observati...
What Conditions Determine Cognition in the Psychiatric Realm?
Erklärende Psychologie Part Three:
Causal Connections of Psy...
The Link With Different Levels of
General Medical Therapy

(a) Doctor applies technical knowledge of cause and
effect and ...
The Link With Different Levels of General Medical Therapy

“…Once the individual has turned into an object,
she can be tre...
Summation
“Thus in therapy the widest polarities lie in
whether the doctor turns to what can be
discovered by science, tha...
Part Six. The Human Being as a Whole
(c.) Philosophy in Psychopathology

“If anyone thinks she can exclude
philosophy and leave it aside as useless
she will ev...
Part Six.“The Human Being as a Whole”
• Scientific obligation to integrate
philosophical anthropology with empirical
facts...
(c) The “Complex Unities” in retrospect and the problem
of a unified whole (GP, 750ff)

I. The momentary whole in which
ex...
c. The complex unities in retrospect
and the problem of a unified whole

IV. The complex clinical unities were the
ideas: ...
False Conversions of Complex Unities into Absolutes
“The momentary whole tends to be taken for the
ultimate whole: the psy...
(d) The concrete enigmata in retrospect

• Constitution
• Limits of Genetic Research
• Performances
• Limitation of unders...
(d) The concrete enigmata in retrospect
• Constitution (an insoluble problem)
• Limits of Genetic Research
• Performances
...
The Encompassing Self
• Ergo, psychopathological knowledge placed in
suspension [sic] at the boundaries of our
knowing vis...
Source: Nature Reviews| Neuroscience
Vol.14, May 2013, 365-375.
III. Mental
Healh StigmaLooking Ahead
Søren Kierkegaard
(1813–1855)

“Once you
label me,
you negate
me.”
• “Mark” or “Attribute;” reduces the

•
•
•
•

•

other from “whole and usual” to
“tainted and discounted;” “Less
than ful...
Stigma in Mental Health

Stigma“co-occurrence of
its components:”

 Labeling
 Stereotyping
 Separation
 Status loss
 ...
Public Stigma of Mental Illness
Stigma in Mental Health
Opening Minds: Anti-stigma,
Anti-discrimination Program (2011)
Stigma in Mental Health
Prevalence of Personal Stigma Reported by
(7% of sample; n >10,000) respondents treated
for emotional or mental health pro...
Changing Directions, Changing Lives:
The Mental Health Strategy for Canada
Mental Health Stigma: Ethical Considerations

UN Convention on the Rights of Persons
with Disabilities): Access to treatm...
Mental Health Stigma: Ethical Considerations

• Stigma violates generic rights to freedom and
well-being
• “Well-being con...
What is Transhumanist Philosophy?

Transhumanism is a contemporary

life philosophy, a global cultural and
intellectual m...
Transhumanists
 Seek radical Extension of Human

Life ‘health-span’
Eradication of disease; elimination
of suffering; ov...
Therapy vs. Enhancement?
Transhumanists aim not so much to cure
disease, but “reach beyond” health

 Lift themselves abo...
“Psychopathologie”
“The belief that it was possible to develop methods
which would enable us to comprehend man as a
whole ...
“Life I can
treat,
but to Freedom
I can only
appeal.”
Karl Jaspers,
The Nature of Psychotherapy:
A Critical Appraisal (The...
Queens university panel celebrating jaspers general psychopathology prof gregory j walters
Queens university panel celebrating jaspers general psychopathology prof gregory j walters
Queens university panel celebrating jaspers general psychopathology prof gregory j walters
Queens university panel celebrating jaspers general psychopathology prof gregory j walters
Queens university panel celebrating jaspers general psychopathology prof gregory j walters
Queens university panel celebrating jaspers general psychopathology prof gregory j walters
Queens university panel celebrating jaspers general psychopathology prof gregory j walters
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100 Year Celebration of Karl Jaspers' General Psychopatholgy

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  • See On Reading the General Psychopathology: The Importance of J’s Methodological Pluralism for Contemporary Psychiatry. Leston HAVENS (pluralistic renewal) in Approaches to the Mind/Psychiatric Movements 1973, 2004; Paul McHUGH and Philip SLAVNEY, Perspectives of Psychiatry- all propose methodological pluralism.
  • Understanding comes up against the meaningless (the ununderstandable) in the form of the causal connections of biology or in the form of Existence itself.” (GP, 755-756)
  • Constitution is a comprehensive concept that contains both medical judgment and a judgment on the whole of the personality and its situation.
    Genetics Research- KJ has four subpoints. I note one only when he writes: …”even if we found the link between genetics and the developmental history, between the genes and the organizers, we should only have grasped mechanical and lifeless connections within the preconditions of life; we should not have grasped that individual life itself.” GP, 753
    On Individuality Jaspers writes: “What is individual cannot be explained in terms of the other; it is its own explanation. It is not to be grasped as a whole for it is ineffable. Dissected though it may be into something biological in genetics and into something psychological in human society and culture, and thus as it were at the cross-roads of heredity and environment, individuality is never just the point of transit but always a mystery, somehow itself, unique, existing for itself in an historic concreteness as present riches; a single incomparable wave in the infinity of waves that mirror the whole.” (GP)
  • The authors argue that the avg. statistical power of studies in the neurosciences is low. They also write inn keeping with Jaspers concrete enigmata vis-à-vis genetic research that “A simulation of genetic association studies showed that a typical dataset would generate at least one false positive result almost 97% of the time, and two efforts to replicate promising findings in biomedicine reveal replication rates of 25% or less.” p.365
  • Basic: the preconditions of action: life, physical integrity, mental equilibrium; Nonsubtractive: the conditions of maintaining action at a successful level: not being hurt or harassed, lied to, or stolen from; Additive: having abilities and conditions for increasing one’s level of purpose fulfillment, education, self-esteem, opportunities for acquiring wealth and income
  • Queens university panel celebrating jaspers general psychopathology prof gregory j walters

    1. 1. Queen’s University Department of Psychiatry GRAND ROUNDS Friday, October 18, 2013 Providence Care – Mental Health Services Amphitheatre 8:00 - 9:00 Gregor y J. Walt ers, PhD Professor of Philosophy Saint-Paul University, Ottawa C. Cabr era, LMS, MSc, MRC Psych. Associate Professor Department of Psychiatry Queen’s University “Empirical and Interpretive Psychiatry Today- Looking Back, Looking Ahead: A Centennial Celebration in Honour of Karl Jaspers's General Psychopathology” These rounds are Royal College, Maintenance of Certification Accredited Learning Objectives on reverse Upcoming Rounds – October 25, 2013 at PC-MHS Nov. 1, 8, 18, 22 & 29 at HDH Coffee & Refreshments will be available prior to rounds
    2. 2. Learning Objectives 1. Jaspersian Echoes: Briefly survey Jaspers’s scholarly reception in North American psychiatry. 2. Looking Back: briefly identify the definition and tasks of phenomenology, outline, levels of medical practice in psychotherapy, and “complex unities,” “concrete enigmata,” and “the problem of a unified whole” in relation to understanding the human being as a whole. 3. Mental Health Stigma-Looking Ahead: briefly identify the problem of mental health stigma, some ethical considerations, and the contemporary relevance of Jaspers’s philosophy to emerging cognitive, emotional and physical enhancement technologies and Transhumanist philosophy.
    3. 3. I. Jaspersian Echoes
    4. 4. Jaspers’s Echoes in North America
    5. 5. Echoes- DSM & Death of Phenomenology
    6. 6. Echoes- DSM-IV,ICD as reified categories
    7. 7. “Antagonomia” & “Idiomania”
    8. 8. Echoes- Perceptual Field Deficit
    9. 9. Echoes- Time Consciousness
    10. 10. Echoes- ‘Joint Reference’ Overcoming Biomedical Bias
    11. 11. Depressive Realism, the Cognitive Distortion Model and Existential Psychotherapeutic Methods
    12. 12. Echoes- Diagnosis & Ideal Types
    13. 13. Echoes- Perspectivism & Methods
    14. 14. II. Looking Back
    15. 15. General Psychopathology
    16. 16. The General Psychopathology
    17. 17. “Phenomenology” Defined (1912) “….Illustrative representation of individual experience (anschauliche Vergegenwärtigung individuellen seelischen Erlebens); an empirical method designed to define experienced mental states– i.e., subjective phenomena – within the narrowest possible confines; to distinguish between them; and to separate them terminologically.” Phenomenology accomplishes all this, “depending on the individual case, by the enumeration of a number of outward characteristics of the mental state, of the conditions under which it occurs, through vivid, illustrious comparisons and symbolizations, through a kind of suggestive representation,” which is based on empathy and which is supposed to enable the reader of a phenomenological description empathically to perceive the phenomenon described.” JASPERS, K. “Die phänomenologische Forschundsrichtung in der Psychopathologie” (1912) Zeitschrift für die gesamte Neurologie und Pscyhiatrie, No. 9, 1912, 391ff., translated in Ludwig B. Lefebre, “The Psychology of Karl Jaspers,” in P.A. Schillp, ed., The Philosophy of Karl Jaspers, 473
    18. 18. Tasks of “Phenomenology” (1913) Provide concrete descriptions of individual psychic states and present them for observation. Review the inter-relations of these, delineates them, differentiates them, and creates suitable terminology. Patients’ self-descriptions are the chief help. Close contemplation of an individual case teaches phenomena common to countless others.
    19. 19. What Conditions Determine Cognition in the Psychiatric Realm? Erklärende Psychologie Part Three: Causal Connections of Psychic Life  Cause-Effect Relationships; Causal Scientific [Statistical] Explanation  Objective causal relationships are “always observed from the outside only.” Allgemeine Psychopathologie, 24  “Ascertainment of empirically existing cause and effect relationships which in themselves cannot be understood but are recognized as necessary.”  Example: Recognition of a connection between the deterioration of performance, on the one hand, and fatigue on the other hand. Verstehende Psychologie Part Two: Meaningful Psychic Connections  Verstehen- “perception of mental phenomenon from within.”  Knowledge based on the intuitional comprehension of “understandable” processes.  Comprehension of meaningful psychological relations demonstrating an “inner causality” as opposed to the “outer [genuine] causality” discovered by explanation.
    20. 20. The Link With Different Levels of General Medical Therapy (a) Doctor applies technical knowledge of cause and effect and through mechanical and chemical means repairs the disturbed connections in the apparatus of life. (b) Submits the living being to certain conditions, of diet, environment, rest or exertion, training [cf. CBT]…facilitates the living being as a whole to help itself. (c) Addresses herself to patient as a rational being…body-psyche unity (neurological, hormonal and morphological unitary structures)
    21. 21. The Link With Different Levels of General Medical Therapy “…Once the individual has turned into an object, she can be treated by technical means, nursing care and skill, but the individual as herself can only discover herself through the mutual sharing of destinies.” (cf. self-concealment vs. revelation) (e) The ultimate thing in the doctor-patient relationship is existential communication; doctor and patient are “fellow-travellers in destiny;” psychiatrist is neither “pure technician” nor “pure authority.” “There is no final solution.” Karl Jaspers, The Nature of Psychotherapy, p.18.
    22. 22. Summation “Thus in therapy the widest polarities lie in whether the doctor turns to what can be discovered by science, that is, to the biological event, or whether he turns to the freedom of man. A mistake is made about the whole of human life, should the doctor in looking at persons let them be submerged in the biological event; so too should he convert human freedom into that sort of being which, like nature, is empirically there and can be used technically as an instrument of therapy. Life I can treat, but to freedom, I can only appeal. (Karl Jaspers, The Nature of Pyschotherapy, 20.
    23. 23. Part Six. The Human Being as a Whole
    24. 24. (c.) Philosophy in Psychopathology “If anyone thinks she can exclude philosophy and leave it aside as useless she will eventually be defeated by it in some obscure form or other. From this springs the bad philosophy in psychopathological studies. Only she who knows and is in possession of her facts can keep science pure and at the same time in touch with individual human life which finds its expression in philosophy.” (GP, Vol.II, 770)
    25. 25. Part Six.“The Human Being as a Whole” • Scientific obligation to integrate philosophical anthropology with empirical facts of scientific psychopathology. • Particular scientific facts must always square with the unified whole to which they belong. • Various wholes prove to be “complex unities” for somatic and psychic investigation.
    26. 26. (c) The “Complex Unities” in retrospect and the problem of a unified whole (GP, 750ff) I. The momentary whole in which experienced phenomena occurred was the state of consciousness. II. The whole of the meaningful connections was the personality. III. The whole of the causal connections was comprised in the several theories.
    27. 27. c. The complex unities in retrospect and the problem of a unified whole IV. The complex clinical unities were the ideas: of the disease entity, of the Eidos, (Constitution, etc.); of the Bios (the individual life – as the whole of the person’s life in time). V. The communal and historical whole of the individual appeared as the state of his society, the objective culture, the historical epoch, the communal spirit as displayed in peoples, states and in the masses. (GP, 750ff)
    28. 28. False Conversions of Complex Unities into Absolutes “The momentary whole tends to be taken for the ultimate whole: the psyche is consciousness and nothing else; the performance as a whole is the only objectivity, the only object for science; the body-psyche unity is reality itself; milieu and culture are absolutes to partake in which is psychic reality; personality is the essence of the psyche, its meaningfulness is its Being; theories grasp the true reality; causal connections are the substance of things, the body is everything, the psyche is only a transit-station for hereditary connections; clinical reality consists of only disease entities, constitutions and the life history as a unit; the individual is a function of society and history.” (GP, 750 – 751)
    29. 29. (d) The concrete enigmata in retrospect • Constitution • Limits of Genetic Research • Performances • Limitation of understanding by biological events and by Existence itself • The unity of an individual life (the Bios) and Chance [Luck] (Jaspers, GP II, 752-754)
    30. 30. (d) The concrete enigmata in retrospect • Constitution (an insoluble problem) • Limits of Genetic Research • Performances • Limitation of understanding by biological events and by Existence itself • The unity of an individual life (the Bios) Insoluble problems as a whole reduced to abstract principles: • ‘Endlessness’ • ‘Individuality’ • ‘That which Encompasses all things’
    31. 31. The Encompassing Self • Ergo, psychopathological knowledge placed in suspension [sic] at the boundaries of our knowing vis-a-vis the complex unities, the concrete enigmata, and “the Encompassing Self.” • The GP anticipates the philosophical idea of the Encompassing: Subject-Being (Body, Intellect, Spirit/Mind (Geist), ‘possible Exiztenz’); Object-Being (World and Transcendence); non-reductionism of any one mode of human being.
    32. 32. Source: Nature Reviews| Neuroscience Vol.14, May 2013, 365-375.
    33. 33. III. Mental Healh StigmaLooking Ahead
    34. 34. Søren Kierkegaard (1813–1855) “Once you label me, you negate me.”
    35. 35. • “Mark” or “Attribute;” reduces the • • • • • other from “whole and usual” to “tainted and discounted;” “Less than fully human.” “Abominations of body” (Physical deformities) “Character blemishes” (Mental illness, addictions, government aid) “Tribal Identities” (Race, gender, religion) Stigma enacted in social interaction; Exclusion from full participation in society; Effects on identity are not Static Ebb and flow with “moral career” and larger societal context
    36. 36. Stigma in Mental Health Stigma“co-occurrence of its components:”  Labeling  Stereotyping  Separation  Status loss  Discrimination  Power exercised
    37. 37. Public Stigma of Mental Illness
    38. 38. Stigma in Mental Health
    39. 39. Opening Minds: Anti-stigma, Anti-discrimination Program (2011)
    40. 40. Stigma in Mental Health
    41. 41. Prevalence of Personal Stigma Reported by (7% of sample; n >10,000) respondents treated for emotional or mental health problem Survey Item (Self-reported impact on): Weighted % Family relationships 32.0% Romantic life 30.% Work or school life 27.5% Financial situation 25.0% Housing situation 18.0% Source: Paradigms Lost: Fighting Stigma and the Lessons Learned. Ed. Stuart, H., Arboleda-Flórez, J., Sartorius, N. OUP, p.10.
    42. 42. Changing Directions, Changing Lives: The Mental Health Strategy for Canada
    43. 43. Mental Health Stigma: Ethical Considerations UN Convention on the Rights of Persons with Disabilities): Access to treatment of mental disorders a human right. The Principle of Human Rights "Act in accord with the generic rights of your recipients as well as of yourself." (Gewirth, 1996,19) • Generic rights are rights to the generic features of action-- freedom and wellbeing-- which constitute the necessary conditions of action.
    44. 44. Mental Health Stigma: Ethical Considerations • Stigma violates generic rights to freedom and well-being • “Well-being consists in having the various substantive conditions and abilities that are proximately required either for acting at all or for having general chances of success in achieving one’s purposes through one’s actions.” (cf. Social Determinants of Health) • 3 Levels of Well-being: Basic, Nonsubtractive, Additive
    45. 45. What is Transhumanist Philosophy? Transhumanism is a contemporary life philosophy, a global cultural and intellectual movement that promotes “an interdisciplinary approach to understanding and evaluating the opportunities for enhancing the human condition and the human organism opened up by the advancement of technology.” (Max More, 2013)
    46. 46. Transhumanists  Seek radical Extension of Human Life ‘health-span’ Eradication of disease; elimination of suffering; overcoming the “genetic lottery.” Enhancement of human intellectual, physical, and emotional capacities by means of psychopharmaceuticals, genetics, molecular nanotechnology, artificial
    47. 47. Therapy vs. Enhancement? Transhumanists aim not so much to cure disease, but “reach beyond” health  Lift themselves above the norm  “one-sided triumph of willfulness over giftedness, of dominion over reverence, of molding over beholding?” (Michael Sandel 2012, 94). Is there “Wisdom in repugnance?” cf. Procreative liberty, Human Cloning? (Leon Kass, 2013)
    48. 48. “Psychopathologie” “The belief that it was possible to develop methods which would enable us to comprehend man as a whole (as to constitution, character, body-type, and disease-entity) persisted, in ever new guises. Despite the fact that, within limits, all of them were fruitful, the supposed totality every time proved to be a totality within the one comprehensive totality of being human, never this totality itself. For the totality of man lies way beyond any conceivable objectifiability. He is incompletable both as a beingfor-himself and as an object of cognition. He remains, so to speak, "open." Man is always more than what he knows, or can know, about himself.” Karl Jaspers, “Philosophical Autobiography,” in P.A. Schillp, ed., The Philosophy of Karl Jaspers, 13.
    49. 49. “Life I can treat, but to Freedom I can only appeal.” Karl Jaspers, The Nature of Psychotherapy: A Critical Appraisal (The University of Chicago Press, 1965 [1964]), 20.  

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