The Continuum of Mental Disorders and Unitary Psychosis: History and Perspectives
This book presents a thorough investigation of Griesinger, Kahlbaum, and Kraepelin’s foundational works in psychiatry. It offers an admirable opportunity to understand their achievements and thoughts, and its historical character makes it accessible to a wide range of readers interested in mental health. The analysis of continuities and discontinuities in their described mental disorders illuminates the current classification and diagnosis debate in psychiatry. This analysis comprises etiologic explanations and methodological grounds for each author’s classification. Implying an interrelation among the disorders, the unitary psychosis allows or demands a comprehensive mental disorder view, which includes the person. In this respect, other psychopathologists are also investigated in this book, and process philosophy is introduced, suggesting a fertile framework for psychopathology. According to German Berrios in his Preface, the book offers a new perspective on the nature and meaning of the concept of unitary psychosis.
A Word from the Author
The book follows the path from the classification of mental disorders to philosophy and the normal mind. All that involves the mind embeds an enigmatic complexity, which includes the delimitation of mental disorders. Ideally, they are distinct natural kinds whose specific cause and anatomical or physiological disturbance are known, or are still to be discovered. But difficulties in fulfilling this ideal for many disorders have always brought suspicions about this way of seeing things. Such mental disorders might indeed have no clear boundaries among them and with the normal mind. Some scholars even deny them.
Conversely, should the way we see them, the method we use, be the reason to capture their different “realities?” Practical necessities also play a role here. Anyone trained to see disease entities at the medical school will undoubtedly look for disease entities among mental disorders. According to the official classifications, the psychiatrist will believe they have found them, or their comorbidity. Here, we are not meaning that psychiatric disorders or diseases (according to the concept of disease and its cut-off point to normal) do not exist. They bring extreme suffering and demand serious health policies, and all possible care. But the way we classify them might be better as more dimensional than categorial. Besides, a dimensional or continuous approach favors the relation between mental disorders and the normal mind.
The book’s origin goes back to the need to analyze these opposite views—discrete disease entities versus no boundaries among them. The method is historical-conceptual, through searching for discontinuities and continuities in the works of Griesinger, Kahlbaum, and Kraepelin. They are essential authors regarding the systematization of mental disorders, whereby Griesinger is known to advocate continuities among them, following the tradition of unitary psychosis. This detailed analysis of continuities and discontinuities reveals the beliefs, methods, and the metaphysical grounds of each author.
It turns to be of valuable content to deepen the knowledge on these remarkable authors in psychiatry. In a static-discriminative view of the main content, the reader will be able to access the roots of the psychiatric classification. Already in a dynamic and more holistic perspective, the book lends itself to an in-depth study of psychiatry and psychopathology, with a special interest in psychology and philosophy as it involves the human mind.
Chapter 1 describes the premises of the work, about continuity of psychosis and unitary psychosis. Since the continuum concept in psychiatry is unspoken or implicit, we find it necessary to deal with it in Chapter 2. It is a valuable investigation and possibly a pioneering chapter within mental health, though a very intricated matter. Aristotle’s concept will be helpful within the scope of the work.
Chapter 3 comprises Griesinger’s scientific and speculative physiopsychological and partly brain anatomical view, referring to his clinical symptomatologic observations and description of the main symptom complexes presented in Chapter 4. These chapters enclose a deep understanding of his work. Though simplistic under today’s point of view, his dynamic neurophysiology, which is also psychological and affected by the environment, embeds embodied and enactive aspects that partially recall current systemic approaches. Through neurophysiology he explains the mental disorders, besides mood, affects, feelings, ideations or representations, circumspection, impulses, will, and freedom. Mood disposition is the psychic tonus, which wears out in more serious disorders compromising the intellect, equivalent to today’s severe schizophrenia. Griesinger considers the person and speaks of a metamorphosis of the self, which is normal in life, typical in adolescents, but can go awry.
Chapter 5 deals with Kahlbaum’s research of disease units and his influential delimitation method and classification. In Chapter 6, possible continuities of his disease forms are investigated. Of especial interest are his “habitual forms” or the “garment” of mental diseases; then his idea of a kind of systemic disease, only marginally mentioned by him but relevant if linked with his detailed description of the symptom complexes or habitual forms. These are continuous and conceivable as a unitary psychosis.
Regarding Kraepelin in Chapter 7, we approach our question on continuities–discontinuities more directly since his work is better known. Special attention will be drawn to his late work, “The manifestation forms of mental disorders.” Here again, a continuity of mental symptom complexes prevails, whose origins would now be reputed to be phylogenesis and impregnate our personality. The personality intercedes between causes and clinical manifestation, making the nonspecificity of the clinical manifestations more understandable.
There is an overview of the above in Chapter 8 and a discussion of the “continuum of psychoses” and “unitary psychosis” concepts, also considering some more recent unitary approaches. In the conclusions, the expectancy of finding specific causes in the sense of disease entities is maintained. Still, it is also pretty much defensible a general disposition for the mental disorders with no boundaries, corresponding to the notion of unitary psychosis. This disposition can both be supra-individual/collective and manifest differently and dynamically in each person.
An additional historical investigation in Chapter 9 shows that this disposition to symptom complexes is not a matter of psychopathology only: it takes part in the normal mind—indeed, in our personality, as Kraepelin conceded. We come to an integrated biomedical, psychological, and sociocultural approach, with growing psychological and philosophical interest. Relevance is placed on the past, to the endogenous bodily dispositions, which are part of our personality that will actively interact with the emerging situations. Hence, embodiment and enactivism play a role. Unlike traditional psychiatric approaches of endogeny according to specific mental disorders, as in melancholy, the book praises a continuous and unitary view of mental disorders. Once we are dealing with merging psychopathological and normal human psychic aspects, we can glimpse an endogenous anthropological structure involved with the mind.
So far, the question arises about which kind of metaphysical orientation or nature view would better conform or underpin the above, which is explored in Chapter 10. Process philosophy has already taken steps in mental health, and its relation specifically to the dynamic-continuous view of mental disorders seems promising to the author. Besides, prominent philosophers sustain that process philosophy can succeed Kantians or neo-Kantians, positivists, and logical empiricists, being currently the most defensible tradition of philosophy. Whitehead is the main investigated process philosopher. In this philosophical stream, compared to phenomenology, it turns out, for example, that intentionality is more broadly conceived. Intentionality encompasses consciousness initially by Husserl, the relation Dasein-world by Heidegger, and the body by Merleau-Ponty. In contrast, by Whitehead, it is in all nature, immersed in panexperientialism or pansubjectivism. In process philosophy (in a sense also in phenomenology) continuity prevails in internal relations rather than the traditional notion of discontinuous enduring substances in external relations, which characterizes materialism.
Besides introducing process philosophy, Chapter 10 relates it with the book’s theme concerning continuity and inner togetherness, physical and mental poles, endogenous bodily character, and the mind–body problem. The way Whitehead sees the body brings rich insights to mind, previously to Merleau-Ponty. Finally, the mental symptom complexes as patterns of a continuum and the unitary anthropological matrix are resumed.
As the reader will readily note from German Berrio’s preface, the theme is complex. The author tries to make it accessible through each chapter, based on the rich history of ideas in psychiatry. Consequently, the investigation on unitary psychosis unveils relevant insights into the human mind itself and perhaps, a piece of the mind–body puzzle is set on the table.
Besides introducing the book, this summary will help assimilate its content.
About the Author
Mauricio Viotti Daker is a psychiatrist, and a former Professor and Head of the Department of Mental Health in the Medical School of the Universidade Federal de Minas Gerais, Brazil. His main interests are diagnosis and classification, as well as philosophy and psychiatry. He received a PhD in Unitary Psychosis from the University of Heidelberg, Germany, and completed a postgraduate degree in Philosophy of Mind and Mental Health at the University of Warwick, UK.
The Continuum of Mental Disorders and Unitary Psychosis: History and Perspectives is available now in Hardback from https://www.cambridgescholars.com/product/978-1-5275-7282-9, where you can also access a free 30-page sample.