Personal Identity and Narrativity in Borderline Personality Disorder: A Phenomenological Reconfiguration.

Borderline personality disorder (BPD) is a complex condition marked by heterogeneity. People with BPD have a profusion of symptoms spread across various levels of lived experience, such as identity, affectivity, and interpersonal relationships. Researchers and clinicians have often resorted to the structuring concept of Self to organize the fragmentation of their experience at the identity level. Notably, using the concept of the narrative self, Fuchs proposed to interpret BPD as a fragmentation of narrative identity. This interpretation of BPD, widely shared, has been challenged by Gold and Kyratsous, who have proposed a complementary understanding of the self through the idea of agency, and to which Schmidt and Fuchs in turn have countered. This article proposes to contribute to this discussion from a phenomenological perspective. First, we will briefly review the discussions around narrative interpretation of BPD. From the problems left unresolved by the discussion, we will then justify the necessity to proceed with a stratification of the self from a phenomenology method. Third, from the thought of the Hungarian phenomenologist László Tengelyi, we will continue with an archaeology of the self, in three layers - self-institution, self-formation, and minimal self - integrating Schmidt and Fuchs' concepts of self, in addition to those of Gold and Kyratsous, but also, to a lesser extent, those of Dan Zahavi. Finally, we will proceed with a phenomenological reconfiguration of the experiences and manifestations associated with the identity axis of BPD.

Centrality and Decentration: A Model for Understanding Disturbances in the Relationship of the Self to the World in Psychosis.

ABSTRACT: A considerable body of phenomenological research has described different ways in which the relationship of the person to the world in psychosis is affected. This literature, however, has lacked an accepted unifying theoretical model and means of quantitatively measuring these disturbances. To address this, the current article seeks to integrate a novel phenomenological model of psychosis offered by Henri Grivois, which is explicitly concerned with centrality or a person's sense of being the center of all things, with empirical research on the integrative model of metacognition, which allows for measurements of decentration or the degree to which persons can form integrated ideas about their place in their larger community. It is proposed that this literature may allow for a model of how psychotherapy can address centrality through the building of intersubjectivity and enhancing metacognition.

Acting on delusion and delusional inconsequentiality: A review.

OBJECTIVES: Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act according to their delusions. This study proposes an investigation of how this issue is addressed in psychopathological literature. METHODS: This article offers a critical review of psychopathological literature which focuses on the influence of delusional ideation on behaviour. RESULTS: Phenomenological psychiatry has relied on the paradox pointed out by Bleuler and Jaspers to emphasize disorders of self-experience in psychosis whereas analytical philosophy of delusion has focused on the psychological status of delusion, regarded as belief, certainty, or imagination. The empirical studies conducted during the past three decades - which were devoted to acting on delusion - focused on violent and safety-seeking behaviours. These studies have shown that these behavioural disorders are motivated by an emotional outburst (anger and/or fear) rather than by delusional content. CONCLUSION: Delusional inconsequentiality can be clarified by conceptual research in phenomenological psychiatry and analytical philosophy, even though its role in the psychopathological processes has not yet been clearly identified or conceptualised. Empirical psychopathology on acting on delusion confirms the delusional inconsequentiality, but only implicitly, by highlighting the role of affectivity (rather than beliefs) in delusional actions. Given the major implications of better understanding this phenomenon, in terms of psychopathology and clinical practices, we suggest considering delusional inconsequentiality as a promising concept which could guide further research in contemporary psychopathology.

Imagination and Self Disorders in Schizophrenia: A Review.

Anomalies of imagination are frequent and handicapping in schizophrenia spectrum disorders (SSDs) but neglected in psychopathology due to the lack of a conceptual framework to model disorders of imagination. Recently, the link between minimal self disorders and pathology of imagination has been emphasized. The aim of the present article is to discuss this initiative by stressing their paradigm drawing on the recent imaginary turn in phenomenological research. Although this field of research is currently very active in philosophy, there are very few translational approaches in psychopathology or cognitive sciences. In this paper, we examine how contemporary research concerning fantasy and imagination can lead to the elaboration of an epistemological and phenomenological framework for schizophrenia research. We first examine the psychopathological literature on anomalous fantasy and imagination in SSDs. Then we propose an exhaustive overview of the imaginary turn of philosophical phenomenology. Further, we examine the theoretical and practical implications of such a recasting of phenomenological research. We show how fantasy and imagination are involved in the embodiment process, and how identity and imagination are interlinked. Finally, we propose an overview of the possible implications for the understanding of psychotherapeutic processes and recovery strategies.

"Social physiology" for psychiatric semiology: How TTOM can initiate an interactive turn for computational psychiatry?

Thinking through other minds (TTOM) encompasses new dimensions in computational psychiatry: social interaction and mutual sense-making. It questions the nature of psychiatric manifestations (semiology) in light of recent data on social interaction in neuroscience. We propose the concept of "social physiology" in response to the call by the conceivers of TTOM for the renewal of computational psychiatry.

[Institutional Psychotherapy during confinement situation: Adaptation of the therapeutic setting in a day hospital. Towards a virtual mental institution]. / Psychothérapie institutionnelle en situation de confinement : adaptation du cadre en hôpital de jour. Vers une institution mentale virtuelle.

Within the context of the SARS-Cov-2 virus epidemic, the Ambulatory Care Unit of the Toulouse University Hospital Center, offering institutional psychotherapeutic care to people with severe and/or disabling psychiatric pathologies, closed its doors to patients on the 16th of March 2020. This article aims to document the necessary adjustments to the care setting during this extraordinary period. As it was, the team had to tell patients to stay at home and to respect rules of social distancing. An inescapable paradox when our work consists precisely in de-confining, connecting, being in contact with each other. Face-to-face meetings, group workshops, the array of our mediations were suspended; the challenge for us was to bring to light what is irreducible or essential in the institutional psychotherapeutic care for psychoses, what must remain active through the confinement. These modifications of the psychotherapeutic setting will be described in terms of constructing a virtual mental institution, based on a setting twisted by the distance but not abolished, telephone consultations opening up to a speculative but not disembodied psychopathological imaginary, and finally a blog as a quasi-materialization of a virtual space. This experience led the team of the Ambulatory Care Unit to radicalize the institution to keep it in its simplest apparatus: a virtual tree structure of the mental institution. The prior interactions between caregivers and patients have been translated (and thus re-created) virtually. As to respect their singular aspects, as well as their fundamental belonging to the collective that supports our institution. This virtual mental institution can therefore maintain the framework that structures our institutional care project, and can link the before and what will be the after of the confinement. For this study, we have conducted an "on-the-spot" analysis of the concrete arrangements of our therapeutic setting from an interdisciplinary perspective: phenomenological, systemic and psychodynamic.

New Insight into Affectivity in Schizophrenia: from the Phenomenology of Marc Richir.

BACKGROUND: According to Karl Jaspers, psychopathology requires a comprehensive method, understood as a systematic exploration of the first-person perspective of the patient's experience. At the same time, however, schizophrenia for Jaspers is characterized by its radical incomprehensibility. In addition, Rümke's so-called "praecox feeling" paradoxically combines the incomprehensibility of schizophrenic experience and the evidence of its pathological manifestation in the encounter. AIM: Through a re-examination of the notions of affectivity and interaffective contact we propose a coherent theoretical model to explain the clinician's paradoxical understanding of schizophrenia. METHOD: Phenomenological tradition regards affectivity as an encompassing phenomenon that connects body, self, world, and others. In our view, only a thorough and systematic link between corporeity and affectivity is able to explain embodied affective resonance as a basis of empathic comprehension. By drawing on the phenomenology of Marc Richir, we will systematically unfold the complex nature of affectivity and lead it back to a twofold constitution of corporeality. CONCLUSION: The Richirian account on affectivity can be fruitfully put into discussion with other recent phenomenological models on schizophrenia. It might be able to exhibit affectivity as the operative ground of minimal self-disturbance and thus argue for its intersubjective dimension.

How to Teach/Learn Praecox Feeling? Through Phenomenology to Medical Education.

Background: The Praecox Feeling (PF) refers to a classical psychopathological concept describing the specific experience of bizarreness arising in the encounter with a person living with schizophrenia spectrum disorders (SSDs). Some studies have shown that experienced psychiatrists take advantage of this experience to perform accurate and rapid diagnostic expertise. It would seem that PF is not contradictory with an operationalized diagnostic approach, but that the PF would intervene at a more tacit level of medical judgment. However, the articulation between the implicit and explicit levels of the psychiatrist's experience in the situation of medical judgment remains little studied, even though it is of crucial importance for structuring the teaching of clinical psychiatry to mental health practitioners. Can diagnostic intuition be learned? Is this experience a kind of "gift" that some may or may not have? Does the PF refer to medical expertise? Methods: To unfold the complexity of his questions this article proposes to conduct an historical, epistemological and phenomenological analysis of the PF. Results: We will first conduct a presentation of historical descriptions of the PF understood as a sensation, intuition and experience, alongside the evolution of the concept of schizophrenia. Then, the article proposes an original phenomenological modelization of the temporal unfolding of the PF. Discussion: The phenomenological conceptualization, informed from empirical evidence will try to account for the paradox of the PF as both lived evidence and indescribable experience. PF will be described as a complex cognitive and embodied process based upon ante-predicative aesthetic sensing which is secondly apprehended as perceptible evidence thanks to clinical typification. This conceptualization relying on Husserl manuscript on intersubjectivity will help to demystify its experiential structure and discuss its relevance for medical education.

Is clinical insight a determinant factor of subjective recovery in persons living with schizophrenia or schizoaffective disorders?

Good clinical insight is predictive of clinical recovery in schizophrenia (i.e. symptomatic remission and functional improvement). However, the recent subjective recovery paradigm (i.e. the self-identity reconstruction process with and beyond psychosis) questioned the relevance of seeking patients' awareness of their medically-defined illness. This study aimed to assess the relationship between clinical insight and subjective recovery in individuals with psychotic disorders. Sixty-seven outpatients diagnosed with schizophrenia or schizoaffective disorder were assessed for clinical insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and for self-rated subjective recovery using the Recovery Assessment Scale (RAS). Among all dimensions of insight, only the unawareness of current symptoms was significantly associated with RAS total score, with illness duration as the only moderating factor. On the final regression model, unawareness of current symptoms was confirmed as the strongest of six factors explaining all together 44% of the subjective recovery variance, whereas clinical insight taken as an independent multidimensional construct did not significantly participate in explaining subjective recovery. Our study highlights the weak and only partial implication of clinical insight in subjective recovery, and invites clinicians to consider the patients' meaning making process of morbid experiences in order to build a self-directed and medically-supported recovery.

Psychiatrists Report Praecox Feeling and Find It Reliable. A Cross-Cultural Comparison.

Background: The psychopathological notion of the Praecox Feeling (PF) refers to an experience of strangeness and bizarreness that arises in a clinician during contact with a patient with schizophrenia. There is evidence that psychiatrists take advantage of this feeling in their diagnostic decisions despite the domination of an operationalized diagnostic approach. Methods: The article presents the results of a survey assessing the self-reported prevalence of the PF among psychiatrists in Poland and compares them with data from West Germany (1962), USA (1989), and France (2017) based on the same survey. Results: The study finds a consistent prevalence of reported feelings suggestive of the diagnosis of schizophrenia among psychiatrists of different cultural backgrounds and times. These feelings are independent of variables such as attitude toward schizophrenia, professional orientation, and professional experience and are considered reliable, even if not the most reliable, by the psychiatrists who have them. The study also finds that intersubjective phenomena, such as problematic affective attunement, gestures, and body language, are considered core to these feelings by the psychiatrists. Conclusions: The evidence confirms that psychiatrists' feelings about patients with schizophrenia are considered diagnostically relevant and calls for more deeply investigating the nature and diagnostic significance of these feelings. The article concludes with some speculations regarding the possible benefits of recognizing the PF in facilitating a psychotherapeutic encounter with psychotic patients.

Reassessing "Praecox Feeling" in Diagnostic Decision Making in Schizophrenia: A Critical Review.

The "Praecox Feeling" (PF) is a classical concept referring to a characteristic feeling of bizarreness experienced by a psychiatrist while encountering a person with schizophrenia. Although the PF used to be considered a core symptom of the schizophrenia spectrum, it fell into disuse since the spread of operationalized diagnostic methods (Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases systems). In contemporary research on schizophrenia, it remains largely unaddressed. This critical review investigates the evolution of the PF in historical and contemporary literature and presents an exhaustive overview of empirical evidence on its prevalence in clinical decision making, its reliability and validity. The review demonstrates that the PF is a real determinant of medical decision making in schizophrenia, although, without further research, there is not enough evidence to sustain its rehabilitation as a reliable and valid clinical criterion. PF-like experiences should not be opposed to any criteriological attitude in diagnosis and would be clinically useful if the conditions of descriptive precaution and rigorous epistemology are maintained. The aim of teaching clinical expertise is to transform this basic experience into a well-founded clinical judgment. Finally, the article discusses the possible relevance of the PF for basic science and clinical research according to a translational approach inspired by phenomenology.

Mania associated with ranitidine: a case report and review of literature.

H2 receptor antagonists can be associated with central adverse drug reactions (ADRs), like confusion, delirium, hallucinations, slurred speech or headaches. We report here a 'serious' case of severe mania leading to hospitalization in a 42-year-old alcohol-dependent man, 4 days after ranitidine introduction. Review of literature showed that this 'very rare' ADR occurs mainly in patients with predisposing factors: age, decrease in renal and/or hepatic function, polymedication, alcohol. Knowledge of this ADR can be particularly important for these drugs widely used as self-medication.

A fenomenologia como base epistemológica e ética do movimento desalienista na frança e no Brasil / Phenomenology as an ethical and epistemological basis of the desalienist movement in france and in Brazil / La fenomenología como base epistemológica y ética del movimiento desalienista en francia y en Brasil

Este artigo tem como objetivo apresentar a fenomenologia como base epistemológica e ética do movimento desalienista da psicoterapia institucional na França e da Reforma Psiquiátrica no Brasil. Descrevemos estes dois movimentos e os principais nomes que fizeram parte de suas histórias em interlocução com a fenomenologia, refletindo sobre como esta pode ser considerada uma base para a prática de profissionais da saúde mental inseridos neste contexto que está em plena transformação. (Re)discutir tais bases nos parece de fundamental importância para reafirmar o sentido epistemológico e ético necessário que fundamenta ambos os processos. Concluímos que a fenomenologia se apresentou e ainda se apresenta como uma via de questionamento das práticas em saúde mental e oferece o fundamento para se pensar uma prática que busca o encontro com os sujeitos, e não somente com a doença mental, e para o processo de desinstitucionalização dos doentes mentais.

This article aims to present the phenomenology as the epistemological and ethical basis of the desalienist movement of institutional psychotherapy in France and the Psychiatric Reform in Brazil. We describe these two movements and the main names that were part of their stories in interlocution with phenomenology, reflecting on how this can be considered a basis for the practice of mental health professionals inserted in this context that is in full transformation. To discuss such bases seems to us to have a fundamental importance in order to reaffirm the necessary epistemological and ethical sense that underlies both processes. We conclude that phenomenology has been presented and still presents itself as a way of questioning mental health practices and offers the basis to think of a practice that seeks the encounter with the subjects and not only with the mental illness, as well as the process of deinstitutionalization of the mentally ill.

Este artículo tiene como objetivo presentar la fenomenología como base epistemológica y ética del movimiento desalienista de la psicoterapia institucional en Francia y de la Reforma Psiquiátrica en Brasil. Describimos estos dos movimientos y los principales nombres que formaron parte de sus historias en interlocución con la fenomenología, reflexionando sobre cómo ésta puede ser considerada una base para la práctica de profesionales de la salud mental insertados en este contexto que está en plena transformación. (Re)discutir tales bases nos parece de fundamental importancia para reafirmar el sentido epistemológico y ético necesario que fundamenta ambos procesos. Concluimos que la fenomenología se presentó y aún se presenta como una vía de cuestionamiento de las prácticas en salud mental y ofrece el fundamento para pensar una práctica que busca el encuentro con los sujetos y no sólo con la enfermedad mental y para el proceso de desinstitucionalización de los enfermos mentales.