Fenomenología de la intersubjetividad en la enfermedad bipolar y en la esquizofrenia / Phenomenology of intersubjectivity and its importance for the understanding of schizophrenia and mood disorders

I. Introduction and clinical observations One of the central features of the group of diseases we call schizophrenia is the alteration at the level of interpersonal relationships. Autism, considered by Bleuler (1911) as one of the primary symptoms of the disease, and contact difficulty, described by Minkowski (1927), are two examples of how far this disturbance reaches. But other symptoms of schizophrenia can also be seen from the same perspective. Thus, in the paranoid syndrome the other becomes so powerful that he can persecute, harass and invade the patient's intimacy. Auditory hallucinations can also be conceived of as a peculiar disturbance of the relationship with an anonymous other. As we showed in a previous work, something similar occurs in instances of coenesthetic schizophrenia. Thus, one patient, suffering from this form of the disease, said in his diary, <

I. Introducción y observaciones clínicas Uno de los rasgos centrales de la esquizofrenia es la alteración a nivel de la relación interpersonal. El autismo de Bleuler y la dificultad de contacto de Minkowski son dos ejemplos de la trascendencia de esta perturbación. Pero también otros síntomas de la esquizofrenia pueden ser vistos desde la misma perspectiva. Así, en el síndrome paranoídeo el otro se torna tan poderoso que puede perseguir, asediar e invadir la intimidad del paciente. También las alucinaciones auditivas pueden ser concebidas como una peculiar perturbación de la relación con un otro anónimo. Walter von Baeyer definió las características de este encuentro interpersonal deformado de los esquizofrénicos, el que se caracterizaría por la falta de reciprocidad, la anonimización y la mediatización. En el delirio de amor, por ejemplo, el paciente no puede defenderse de las voces amorosas o de las alucinaciones cenestésicas vinculadas a la esfera sexual. Por otra parte ese tú invasor, que en un comienzo tiene un nombre, va perdiendo su individualidad para hacerse colectivo. Por último, ese contacto con el otro alucinado se mediatiza, a través de aparatos como radios o televisores. En la depresión también observamos una profunda alteración de la esfera interpersonal. Se podrían distinguir dos formas de depresión: las delirantes y las no delirantes. En la primera la sintomatologia está comandada por el delirio (de culpa, ruina o enfermedad) y en las segundas por los síntomas corporales, la experiencia del <

Eros y Tánatos / Eros and thanatos

Eros and Thanatos, respectively, love and death, are universal subjects in which human beings have been interested since the beginning of history and also probably, their access to language. The greatest philosophers, poets and novelists have focused on these subjects in their reflections and/or their own development. Fully conscious of the lack of moderation of the task proposed, the author intends to make a modest contribution to these two concepts and what they represent, inspired by two sources: classical myths, on the one hand, and the work of some poets and thinkers, mainly Plato, Goethe and Rilke, on the other hand. Eros or love In most ancient Greek myths, eros is considered as one of the great constitutive and constituent principles of the universe, as the irresistible force allowing the continuity of life in human beings and animals, in the earth and in the waters. But eros is also a god and his legend shows us some essential features of love: 1. Love is involuntary, it occurs, it happens, like a disease. Eros had the mission of punishing Psyche for her beauty, thus avenging the jealous Aphrodite, his mother. And however, it was enough for him to look upon her only once to become impassioned by her. But this passion goes together with its opposite, liberty, because love always carries implicit a choice. 2. Love, unlike friendship, which is slowly shaped, appears in a sudden way, represented by the arrows used by Eros (Cupid) to inflame lovers' hearts. Safo described this phenomenon of suddenness superbly. 3. The myth also teaches us the exclusive character of love. This feature separates love from erotism. Some verses by the poet Gonzalo Rojas are quoted to illustrate what he calls <> to exclusiveness. 4. Another characteristic of love inferred from the myth is transgression, which almost always accompanies it. Eros did not have the right to fall in love with a mortal woman and, however, he is not able to withdraw from the feeling invading him. Great loves in the history of literature, such as Romeo and Juliet, Werther or Anna Karenina, are essentially presented in a background of transgression. 5. In mythical narrative there are two other elements, though not essential, which are worthy of interest in this context: that Psyche, the beautiful woman in love, be the representative of the human soul, and that one of her attributes be curiosity. The subject of eros cannot be approached without mentioning <> by Plato. From this memorable text the author underlines part of the content of two of the speeches, the one by Aristophanes and the one by Socrates. From the myth of the androgyne, narrated by the former, at least three teachings are deduced: first, that the strength of eros would derive from the nostalgia felt by the lover for the loved one, or vice versa, since in a remote past their bodies would have been merged, to be violently separated by Zeus in some moment; second, love would consist of a search and eventual recognition of that <>; and third, this recognition would occur through a symbolon, a sort of countersign that humans gave each other on the moment of being separated. Thanatos or death The etymological root of the word thanatos is tha and it is curious that the only other Greek word with the same root is thalamon, the nuptial chamber. The thalamon is the place of the house where the wife lives, and it is the most central room but also the darkest. Thanatos or death appears, then, related on the one hand to darkness and confinement, and on the other hand, to woman and love. The love and death context is illustrated by a beautiful poem by Gonzalo Rojas, simply named <>. In the realm of psychology and psychiatry, Sabine Spiel rein, but particularly Sigmund Freud, counterposed the death impulse or instinct (Todestrieb) to a life instinct. However, philosophers like Hegel and Heidegger have conceived death as an essential part of life. Heidegger even states that it is the most proper possibility of human existence. In order to deepen the context of love (or life) and death, this author proceeds to analyze the famous poem by Goethe <> (Blessed longing), inspired by the love of the butterfly for the flame, which will mean its death. It is here where Goethe postulates his famous principle of Stirb-werde (dying and becoming). But who has taught us the most about the harmony between life and death is the Prague-born German poet, Rainer Maria Rilke, particularly in his famous Duino Elegies and in his requiems. Before analyzing some of these poems, the author quotes a letter written by Rilke to his editor in Polish, where he affirms, among other things, the following: <>. In the elegies the poet teaches us regarding our subject: first, that the human being is the only being in the universe aware of death, because neither animals nor gods know it; second, that awareness of death is the origin of anxiety, but at the same time, what gives meaning to life; third, that the mission of the human being in life is twofold: <> to things, that is to say, to make them be born from nothingness, and then <> them from their mortality, from death, to make them <>, that is to say, making them eternal. Now, if the mission of human being in relation to the things is to name and to save them, with respect to him/herself, his/her task will be <>. In sum, thanatos does not mean destruction nor is the source of all our misfortunes, but an essential part of life itself. As ethimology taught us, thanatos has a common origin with thalamon, that place in the house where the mother and wife lives. It is perhaps the darkest, but at the same time the most central part of the house. Human life can be conceived as the way from this center and back to it.

Eros y Tánatos, o el amor y la muerte, son temas universales que han preocupado al hombre desde los comienzos de la historia. Los más grandes filósofos, poetas y novelistas han puesto estos temas en el centro de su reflexión o desarrollo. El autor se propone hacer un modesto aporte a estos conceptos, inspirado en dos fuentes: los mitos clásicos, por una parte, y la obra de algunos poetas y pensadores, como Platón, Goethe y Rilke, por otra. Eros o el amor En los mitos griegos más antiguos, el eros es considerado como uno de los grandes principios constitutivos y constituyentes del universo. Pero al mismo tiempo es un dios y su leyenda nos muestra algunos rasgos esenciales del amor: 1. El amor es involuntario, ocurre, pasa, como una enfermedad. Eros tenía la misión de castigar a Psiquis por su belleza, para vengar así a la celosa Afrodita, su madre. Y sin embargo, le bastó mirarla una vez para caer encendido en el sentimiento amoroso. 2. El amor, a diferencia de la amistad -que se va forjando lentamente-, aparece en forma súbita, hecho representado en las flechas que emplea Eros o Cupido para encender el corazón de los amantes. 3. El mito nos enseña también el carácter exclusivo del amor. Este rasgo distancia al amor del erotismo. 4. Otra característica del amor que se desprende del mito es la trasgresión que casi siempre lo acompaña. Eros no tenía derecho de enamorarse de una mortal y, sin embargo, no es capaz de sustraerse al sentimiento que lo invade. 5. Hay otros dos elementos en el relato mítico que, aunque no esenciales, son de interés en este contexto: que Psiquis, la bella enamorada, sea la representante del alma humana y que uno de sus atributos sea la curiosidad. No se puede abordar el tema del eros sin mencionar <> de Platón. De este texto memorable, el autor destaca dos de los discursos, el de Aristófanes y el de Sócrates. Del primero se desprenden al menos tres enseñanzas: 1. Que la fuerza del eros derivaría de la añoranza que siente el amante por la amada, o viceversa, puesto que en un pasado remoto sus cuerpos habrían estado unidos, para ser violentamente separados por Zeus. 2. El amor consistiría en una búsqueda y eventual reconocimiento de esa <>. 3. Este reconocimiento ocurriría a través de un symbolon, una suerte de contraseña que nos dimos los humanos unos a otros antes de ser separados. Tánatos o la muerte La raíz etimológica de thanatos es tha y la única otra palabra griega con la misma raíz es thalamon, el tálamo nupcial. El thalamon es el lugar de la casa donde habita la esposa y es la habitación más central, pero también la más oscura. Thanatos o la muerte aparece vinculada entonces, por un lado, a la oscuridad y al encierro y, por otro, a la mujer y al amor. En el ámbito de la psicología y la psiquiatría, Sabine Spielrein y sobre todo Sigmund Freud contrapusieron, al instinto de vida, el impulso o instinto de muerte (Todestrieb). Sin embargo, filósofos como Hegel y Heidegger han concebido la muerte como parte esencial de la vida. En orden a profundizar el contexto vida (o amor) y muerte, el autor procede a analizar el famoso poema de Goethe, <> (<>), donde postula su famoso principio del Stirb-werde (muere para llegar a ser), poema inspirado en el amor de la mariposa por la llama, que significará su muerte. Pero quien más nos ha enseñado la armonía de la vida y de la muerte es el poeta Rainer Maria Rilke, particularmente en sus famosas Elegías del Duino y en sus réquiems. En las elegías, el poeta nos enseña al respecto: 1. Que el hombre es el único ser en el universo que tiene conciencia de la muerte. 2. Esa conciencia de la muerte es el origen de la angustia pero, al mismo tiempo, lo que le da sentido a la vida. 3. Que la misión del hombre en su vida es doble: <> de su caducidad, de la muerte, haciéndolas <>, es decir, eternizándolas. Ahora, si la misión del hombre con respecto a las cosas es nombrarlas y salvarlas, con respecto a sí mismo su tarea será <>. En suma, tánatos no significa destrucción ni tampoco es la fuente de todas nuestras desgracias, sino que es parte esencial de la vida misma. Como nos enseña la etimología, thanatos tiene el mismo origen que thalamon, el lugar de la casa donde habita la madre y esposa: quizás el más oscuro, pero también el más central. La vida humana es el camino desde y hacia ese centro.

Fenomenología de la obsesividad / Phenomenology of obsessiveness

Siguiendo la tradición de investigadores de la corriente fenomenológico-antropológica como Straus, von Gebsattel, Tellenbach y Blakenburg, intenta el autor aproximarse al trastorno obsesivo-compulsivo desde una perspectiva fenomenológica. Esta implica un renunciar a todo tipo de ideas previas sobre el fenómeno en cuestión, lo que incluye por cierto consideraciones genéticas, neurobiológicas o clínico-estadísticas. El autor emplea como punto de partida un caso clínicamente típico que le tocó estudiar y tratar psicoterapéuticamente durante muchos años. Luego de detenerse brevemente en las interesantes conexiones psicodinámicas entre los síntomas y la biografía de la paciente, el autor pasa a analizar el mundo obsesibo mismo desde la perspectiva de su espacialidad y de su temporalidad. En relación con la primera, se destaca el hecho de que los dos rasgos propios de la espacialidad humana, según Heidegger, el des-alejar y el conceder, se encuentran específicamente alterados en el fenómeno obsesivo. En lo que se refiere a la temporalidad, el autor pone de manifiesto la circularidad y la esterilidad del tiempo obsesivo (lo contrario de la creatividad que se desarrolla en el tiempo lineal), a lo que se agrega el hecho de que sus ritos no representan la superación del tiempo del rejoj, como ocurre en el rito religioso, sino por el contrario, el máximo sometimiento al terrible dios Chornos

Following the tradition of researchers of the phenomenological-anthropological school such as Straus, von Gebsattel, Tellenbach and blankenburg, the autor attempts to approach the obsessive-compulsive disorder from a phenomenological perspective. This means setting aside any previous ideas about the phenomenon in question, including genetic, neurobiological and clinical-statistical considerations. He takes as his starting point a clinically typical case he studied and treated with psychoanalytically oriented psychotherapy for many years. After delving briefly into the interesting psychodynamic connections between the patient´s symptoms and life story, he proceeds to analyse the obsessive worls itself from a spatial and temporal point of view. Regarding the former, he points out that the features associated with human spatiality, according to heidegger, the tendency to dimish distance and concede space, are specifically aletered in the obsessive phenomenon. With respect to temporality, the author demonstrates the circularity and sterility of obsessive time (unlike that of creativity, which evolves in linear time), and the fact that the rites involved do not represent a victory over the rule of the clock, as religious rites do, but rather the deep submission to the rerrible god Chronos

En torno al sentido del dolor

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Abstract: Pain and suffering have always accompanied man. We find them in the most ancient myths and particularly in the Book of Genesis. Pain is apparently something innate in man and to a certain extent peculiar to him. This is clear when Yahweh tells the woman, "In sorrow thou shalt bring forth children" (Chapter 3, Vers. 16) and the man, "In the sweat of thy face shalt thou eat bread" (Chapter 3, Vers. 19) and not long before he had told him that from now on life would give him "thorns and thistles" (Chapter 3, Vers. 18). Now, how could man, who in Paradise lived in a state of full happiness, not know pain before his "fall", when he also had body, like the animals? Or is it perhaps a matter of different kinds of pain? One possibility of understanding this biblical assertion is to think that the mythical text refers to suffering and not to pain. We would share the latter with animals, while suffering would be peculiar to the human being. But it just happens that, as we will see later, the boundary between suffering and pain is very diffuse and there are pains that are neither the result of action of an external agent nor identifiable with suffering (due to something lost, for example). Alfred Prinz Auersperg, disciple and collaborator of Viktor von Weizsácker in the development of the Circle of the Form's Theory (Gestaltkreis), published in 1963 a book entitled "Pain and painfulness", where he clearly distinguishes two types of pain, sensation-pain and feeling-pain. The former is more localized, abrupt in its presentation and passes without leaving traces. Examples of this kind of pain are those caused by a stabs or burns. The latter is more diffuse and comes about gradually. It is the case of migraine, of the irritable bowel syndrome, of lower back pain, etc. This second type of pain is common in psychic diseases, particularly in depression. In its masked forms, the enti-re syndrome revolves round the painful experience, with the alteration of patient's mood and vital rhythms trapped in a sort of semi-darkness. Moving up from the most somatic, now we should ask ourselves about the role of pain as suffering in depression. Here we see a sort of paradox, because the facies of the depressive patient represents in a way the maximum expression of suffering, but at the same time one often hears these patients complaining about a freezing of emotions, an inability to feel and thus to suffer and so, some come to believe they are incapable of loving their children, their spouses or their lovers. The difficulty we experience when trying to apprehend vital feelings is really that of separating our-selves from them, because they are continuously determining what we are thus our way of looking at the world. In pain, be it exteroceptive or interoceptive, it is the body that hurts. In suffering, on the other hand, what hurts is the meaning of what occurs to me. The two forms have at least two features in common: one is their pathic nature, that is, that they are outside forces that happen to us, they do not derive from our will like movement and action. The second feature is that both isolate, interrupt our commitment relationship with the world. Pain, because it causes a lose of body transparence and suffering, because the reason for it completely absorbs our attention. Count the former as a previous explanation to the question about the possible sense of pain and/or of suffering. We will try to give an answer to this question from two different perspectives: one historical and another hermeneutic. The latter consists of resorting to the later works of Rainer Maria Rilke, a poet who in his work has illuminated many contexts, but one in a masterful way: suffering and pain. For the ancient Semites pain was a consequence of sin, fault committed either by ourselves, by our ancestors or by our first parents (original sin). In New Testament pain occupies a central place in the life and death of Jesus Christ. By His sacrifice the human race has been redeemed and reconciled with God. The message of the cross eventually becomes a message of resurrection and of life. In consequence, for the Christian pain cannot but belong to the very essence of life. This conception was valid during the first nineteen centuries of Christian-Western civilization. Starting from the second half of the 19 Century, five discoveries will shake up the very foundation of this conception of the world: a) anxiety, described by Kierkegaard, b) evolution, Darwin's theory, c) power of economic forces described by Marx, d) the absurd, put forward by Nietzsche, and e) the unconscious, studied by Freud. Rapidly appeared secularization, the "death of God" and the oblivion of His Providence; then totalitarianisms, with the consequences known by all and now we are in the midst of postmodernity, with rampant technological development, the destruction of the environment, genetic manipulation and a false sense of freedom, where everything seems to be allowed, up to the point of living surrounded by the most extreme forms of obscenity. The author appeals then to the later poetry of Rilke to answer the question of the possible sense of pain. The author tries to make a hermeneutical analysis of some poems, that is to say, an interpretation as unprejudiced as possible, in the sense of allowing the text to speak for itself. Thus, for example, in Sonnet XIX from the First Part of the Sonnets to Orpheus, the poet says: "Pain is beyond our grasp, / love hasn't been learned, / and whatever eliminates / us in death is still secret. / Only the Song above the land / blesses and celebrates." According to Heidegger, this poem reveals to us the "co-belonging" of pain, of love and of death, an idea of which modern man remains oblivious. But we still have the song, there where the word and the music meet, a song that sanctifies and celebrates life and that will allow us to illuminate that "abyss of the being" where pain, love and death cobelong. In the second sonnet chosen, Number VIII of the first part, the poet says: "Only in the sphere of praise may Lamentation walk, / water-spirit of the weeping spring / who watches closely over our cascading / so it will be clear even on the rock / that supports the gates and altars". In these verses the nymph watches to ensure that the spring of our tears (of suffering) -which in turn constitute our "sediment", that is, our essence- is purified when passing or colliding with the same rock on which our temples are built. Later on he will assert that suffering and celebration, like thankful prayer to the gods, always go together. Toward the end of the sonnet this pain embodied in that being called the Lamentation by the poet is transformed into the true intermediary between men and gods. In the Ninth Elegy suffering appears as one of the highest values, together with love: "Ah, but what can we take across / into the realm? Not the power to see we've learned / so slowly here, and nothing thafs happened here. / Nothing. And so, the pain; above all, the hard / work of living; the long experience of love - / those purely unspeakable things." Seldom has pain been so exalted. It is much more important than everything seen, heard or experienced, more than everything done and consummated throughout life. And the only thing that is at the level as pain is "the long experience of love". The idea of the transcendence of pain appears again in the Tenth Elegy, that represents the culmination of the cycle and whose subject is precisely the transit from this world to the next: "And then how dear / you'll be to me, you nights of anguish. / Sisters of despair, why didn't I kneel lower / to receive you, surrender myself more loosely / into your flowing hair. We waste our sufferings...". And further on the poet shows us that pain constitutes the ultímate sense of human existence: "... But they' re nothing more / than our winter trees, our dark evergreen, one / of the seasons in our secret years - not just a season, / but a place, a settlement, a camp, soil, a home".

Aproximación al tema del delirio como una posibilidad humana / Delusion as a human possibility

Es frecuente que en psiquiatría y psicopatología se emple en palabras con un claro sentido peyorativo, como "psicópata", "loco", "demente", "histérico", "defectual", etc. Incluso en orientaciones menos médicas y más antropológicas, como la de L. Binswanger, por ejemplo, nos encontramos con el uso frecuente de expresiones como "fracaso" (existencial), "estancamiento", "descarrilamiento", etc. La progresiva psiquiatrización de la vida moderna ha acentuado aún más la tendencia a calificar negativamente aquellos rasgos del vivenciar o del comportamiento que en algún sentido se alejan del término medio. Desde el punto de vista histórico, la exageración de esta actitud ha llevado al menos a dos casos de abusos masivos de los que la comunidad tendría que avergonzarse: "la higiene racial" nazi (que como es sabido también se aplicó a los enfermos mentales) y el uso político de la psiquiatría en la ex Unión Soviética. El autor se propone en este trabajo sobre el delirio no buscar en él ni la deficiencia ni la alteración, sino más bien lo que hay en él de un proceso transformador lleno de sentido. Con el objeto de profundizar en el concepto de "transformación" recurre a un soneto de R. M. Rilke y para comprender las semejanzas y diferencias entre la experiencia religiosa psicótica y la normal, se apoya en algunos ejemplos clínicos y en algunos textos religiosos y mitológicos. De lo anterior se desprende - entre otras características positivas del proceso psicótico - que estos enfermos tienen una capacidad de tolerar la proximidad de lo divino que los normales han perdido ya hace mucho tiempo

In psychiatry and psychopathology words with a frankly pejorative connotation are frequently used, such as "psychopath", "mad", "demented", "hysterical", "deviant", etc. Even in less medica) and more anthropological orientations, such as that of Binswanger, for example, we find ourselves with the frequent use of expressions such as (existential) "failure" or "stagnation", "derailment", etc. The progressive "psychiatrization" of modern life has intensifíed the tendency to disparage those features of living or behaving which in some sense deviate from the norm. From a historical point of view, the dominance of this approach has led at least to two cases of massive abuses of which the world and particularly the profession should be as hamed: nazi "racial hygiene" (which as is well known, was also applied to mental patients), and the política' use of psychiatry in the former Soviet Union. In this paper on delusion, the author proposes not to look for what is wrong in delusion or to investigate the alteration it causes, but rather the extent to which it involves a mean ingful process of transformation. In order to explorethe concept of "transformation" he refers to a sonnet by R.M. Rilke, and to under stand how the psychotic religious experience is similar to and different from the normal religious one, he relies on some clinical examples and some religious and mythological texts. From the a bone can be inferred, among other positive characteristics of the psychotic process, that these patients have an abilityto tolerate the neamess of the divine, which normal people have lost long ago

[Phenomenological and ethical aspects of aging and dementia]. / Aspectos fenomenológicos y éticos del envejecimiento y la demencia.

Aging is a difficult stage in human life, due to the limitations it imposes and the nearness to death. Modern society tends to be prejudiced against oldness. When dementia is also present, prejudices can be transformed into rejection. The aim of this author tries to devise a phenomenological description of oldness and points out its potentially positive aspects. Following Scheller's classification of dementias (1965), this author tries to determine the common elements of their different forms, using the phenomenological method, which can be applied either to one or to many cases of aging or dementia, not being the number of observations the fundament of the study, as in the case of empirical sciences. Three essential features characterize the spatiality of aging: distance, reduction of mobility and coexistence of the essential and the tangential; temporality is characterized by slowing, coexistence of essential and trivial elements and predominance of present over future and past. In the case of dementias, all characteristics attributed to senescence are exaggerated and/or deformed, for example, <> is transformed into indifference or <> becomes a paralysis of temporal development. Now, regarding the main forms of dementia, this author sees their common feature in the loss of the Ego's ability to rise above the immediate situation, to be able to reflect on the environment and on him or herself. This wide vision both of aging and of the dementia process enables the author to identify the prejudices weighing over old age that must be overcome, as well as the reasons to respect and take care of the elderly when they are caught in a process of deterioration.

Fenomenología del amor y psicopatología

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Abstract: The question posed by this author is how the universal human phenomenon of love is disturbed in the leading psychopathological syndromes. With a view to answering this question, he proceeds first to make a phenomenology of love, for which he will analyze its spatiality and its temporality. The following step will be to show the way that these anthropological dimensions appear deformed both in schizophrenia and in melancholia. Spatiality of human love In daily life the space of dimensions remains rather hidden, and thus the "above" means "on the roof" and the "below" is understood as "on the floor". Every "where" is discovered through the relationship with things and is not determined by spatial measurements. The geometrical space, the artistic or the religious, etc. are possible because the human being is already spatial from his/her structure itself as "being-in-the-world". Now, the human spatiality has, according to Heidegger, two fundamental characteristics: das Ent-fernen, which could be translated as "removing", that is to say, the human being tendency to make disappear the distances, and das Einraumen, which has, in its turn, two meanings: clearing or cleaning, and conceding or giving. The first corresponds to the "principle of vital space", origin of aggressiveness and competence, about which K. Jaspers affirms: "Every position I conquer excludes some other by claiming for me part of the limited available space". Love represents the ex treme case of the second meaning: to concede or to give space. "Only where you are, a place for me is born", tells us the poet R. M. Rilke. In love not only there is no displacement of the other, but also there is creation of a new space, "our" space, whose most perfect realization is the embracement. It does not enclose the danger of fusion and loss of freedom because, as Rilke goes on to say, "no one can damage the other by limiting him/her; on the contrary, lovers constantly give each other space, breadth and freedom". The spatiality of love in schizophrenia and melancholia The schizophrenic lives in relation to the other with a great fear of closeness. The other is maintained at a distance through delusion, inadequate behaviors, eccentric plans or autism. In loving relationships the closeness of the other becomes unbearable for them and they frequently react in a paranoid way, which is exacerbated by their difficulty to correctly interpret messages from the other. The limitation of the loving capacity resulting from the failure to create the common space, is also revealed to us in typical triggering situations: love declaration, engagement (the Verlobunskatatonie from the classic German authors), homosexual seduction, entry into group organizations, etc., all situations having in common the fact that the other passes the limits they need to impose in order to maintain their fragile structure. Finally, it would be necessary to add that the loss of the ability to meet with the other in love also means that the world goes from being a home, a dwelling place, to an abstract geography, a place threatened by anonymous voices and enemies, where there are no walls keeping out the alien. Here the very basis of interhuman encounter itself -the fact of being unique, free and personal- has been lost. In melancholia space acquires characteristics to a certain extent polarly opposite to schizophrenia. It is warm and ordered; it is a space, where the kept objects retain the past and avoid change. The limits between the proper and the foreign are here very precise, as are too as the ranks governing human relationships. During the depressive phase this space loses color and perspective and, although the boundary between the familiar and the strange does not disappear, the space is reduced, because of a sort of "inflation" affecting the body, which begins to invade the patient through anxiety, discouragement and painful sensations. The depressed patient cannot tolerate the distance of the other, so much so that the most frequent triggering situations are constituted by separations and losses. Their exaggerated tendency to organize and to stick to persons and things indicates to us, for its part, the existence of a disturbance of that form of spatiality already mentioned: "das Einraumen", that is to say, giving, conceding space to the other. The depressive space is the contrary of that taught to us by Rilke in the "Requiem for a friend" (1908) as most properly pertaining to love: "Since that is guilt, if indeed something can be guilt: not to increase the liberty of the beloved...". The temporality of human love With time it occurs as with space; it is only a derivative, an abstraction of the existential time. And thus, the human being is always temporal by virtue of his very structure as being-in-the-world, as expressed by Heidegger. And the reason is that the motor of this structure is the care, cure or concern (die Sorge), where the past, present and future are articulated. In every action we are anticipating and interpreting the future from a determined "feeling ourselves" (the past) and we are carrying out the act of encountering ourselves with something or with somebody (in the present). Now, this time is constituted from finiteness, that is to say, from death, and its central feature is the passing. The time of love, by contrast, is the opposite of chronos, of that all-consuming passing time. The English poet Elizabeth Barrett-Browning com pares the life that passes and the love that remains ("love that endures, life that disappears"), while Schiller says to his beloved: "Only thinking that previously we cared less for each other upsets me, because love must see eternity backwards and forwards". This temporality of duration that we find in human love, and which opposes the temporary nature of life, is also observed in the realm of the religious and it is expressed in a very particular way in the rites. Finally, it would be necessary to add that the poets teach us how love is not only able to access the time of the eternal, but also to vanquish death. And thus Wagner's poetic version of the old legend of Tristram and Isolde sings: "The old song has repeated it: / to love and to die, / but no, no, it is not so! / To love! To love! / To love even in death / and not to die of love." The temporality of love in schizophrenia and melancholia The most characteristic feature of schizophrenic time is a certain degree of "atemporality". The past is never really overcome, because they remain in the symbiotic relationship with the mother seen in the first year of a baby's life. Moreover, their delusions persevere both in the content and in the form, which makes them in a certain way immune to the passing of time. As for the future, we observe a lack of purpose and almost an absence of the phenomenon of "anticipation", the very "motor" of human life. Finally, the schizophrenic patients show great difficulty to carry out (in the present) the tasks corresponding to their intellectual and socio-cultural level; hence, the frequent failures of gifted youth in their studies and of adults in work. The symptom of apathy is merely another form of disturbance of the relationship with the present. This "atemporality" has nothing to do with the "intemporality" of love. The schizophrenic is outside of time, while lovers have overcome it. The schizophrenic becomes detached from that time that passes, which is what allows action. The lovers, instead, go on acting and creating, but they are indeed able to overcome, through love, the sad and painful nature of time: the fact that so many things that one would like to retain are destroyed and inexorably pass. This eternity of love is what brings the lovers to live often in a state of ecstasy. Nothing of that shows the "atemporality" of the schizophrenics, who rather tend to live in a constant disappointment, pursued by a sort of primary anxiety. In depression time passes slower, and in extreme cases such as stupor, stops. The patient has difficulties in thinking, concentrating and making decisions; his/her movements are slow, he/she takes long answering and his/her words are heard without force. Now it is not, obviously, chronological time that stops, but the immanent time associated with life, time as maturation and growing. But as occurred with spatiality, in the previous personality of depressive patients the alteration of temporality is already noticed in that rigid way of carrying out acts, in the constant attempt to plan the future and prevent fate and in the inability to tolerate separations. And thus, the depressed patient cannot, when loving, transcend together with the beloved the space of dimensions and the time of hours. And this explains why each loss pushes him/her deeper into the abyss and that later less important situations can be enough to trigger the depressive process. Compared to the temporality of the depressed patient, the time of love appears to us in all its luminosity: eternity lightning past, present and future, fertility in all that richness that can emerge in the encounter, maturation and personal growth as envisioned by Plato.

Aspectos fenomenológicos y éticos del envejecimiento y la demencia / Phenomenological and ethical aspects of aging and dementia

Aging is a difficult stage in human life, due to the limitations it imposes and the nearness to death. Modern society tends to be prejudiced against oldness. When dementia is also present, prejudices can be transformed into rejection. The aim of this author tries to devise a phenomenological description of oldness and points out its potentially positive aspects. Following Scheller's classification of dementias (1965), this author tries to determine the common elements of their different forms, using the phenomenological method, which can be applied either to one or to many cases of aging or dementia, not being the number of observations the fundament of the study, as in the case of empirical sciences. Three essential features characterize the spatiality of aging: distance, reduction of mobility and coexistence of the essential and the tangential; temporality is characterized by slowing, coexistence of essential and trivial elements and predominance of present over future and past. In the case of dementias, all characteristics attributed to senescence are exaggerated and/or deformed, for example, ®distance¼ is transformed into indifference or ®slowing¼ becomes a paralysis of temporal development. Now, regarding the main forms of dementia, this author sees their common feature in the loss of the Ego's ability to rise above the immediate situation, to be able to reflect on the environment and on him or herself. This wide vision both of aging and of the dementia process enables the author to identify the prejudices weighing over old age that must be overcome, as well as the reasons to respect and take care of the elderly when they are caught in a process of deterioration.

El delirio como posibilidad existencial / The delirium like existential possibility

Es frecuente que en psiquiatría y psicopatología se empleen palabras con un claro sentido peyorativo, como "psicópata", "loco", "demente", "histerico", defectual", etc. Incluso en orientaciones menos médicas y más antropológicas, como la de L. Binswanger, por ejemplo, nos encontramos con el uso frecuente de expresiones como "fracaso" (existencial), "estancamiento", "descarrilamiento", etc. La progresiva psiquiatrización de la vida moderna ha acentuado aún más la tendencia a calificar negativamente aquellos rasgos del vivenciar o del comportamiento que en algún sentido se alejan del término medio. Desde el punto de vista histórico, la exageración de esta actitud ha llevado al menos a dos casos de abusos masivos de los que la comunidad tendría que avergonzarse: "la higiene racial" nazi (que como es sabido también se aplicó a los enfermos mentales) y el uso político de la psiquiatría en la ex Unión Soviética. El autor se propone en este trabajo sobre el delirio no buscar en él ni la deficiencia ni la alteración, sino más bien lo que hay en él de un proceso transformador lleno de sentido. Con el objeto de profundizar en el concepto de "transformación" recurre a un soneto de R.M. Rilke y para comprender las semejanzas y diferencias entre la experiencia religiosa psicótica y la normal, se apoya en algunos ejemplos clínicos y en algunos textos religiosos y mitológicos. De lo anterior se desprende - entre otras características positivas del proceso psicótico - que estos enfermos tienen una capacidad de tolerar la proximidad de lo divino que los normales han perdido ya hace mucho tiempo.

Aproximación al tema del delirio: una posibilidad humana / Introduction to the subject of delusion a human possibility

Es frecuente que en psiquiatría y psicopatología se empleen palabras con un claro sentido peyorativo, como "psicópata", "loco", "demente", "histérico", "defectual", etc. Incluso en orientaciones menos médicas y más antropológicas, como la de L. Binswanger, por ejemplo, nos encontramos con el uso frecuente de expresiones como "fracaso" (existencial), "estancamiento", "descarrilamiento", etc. La progresiva psiquiatrización de la vida moderna ha acentuado aún más la tendencia a calificar negativamente aquellos rasgos del vivenciar o del comportamiento que en algún sentido se alejan del término medio. Desde el punto de vista histórico, la exageración de esta actitud ha llevado al menos a dos casos de abusos masivos de los que la comunidad tendría que avergonzarse: "la higiene racial" nazi (que, como es sabido, también se aplicó a los enfermos mentales) y el uso político de la psiquiatría en la ex Unión Soviética. El autor se propone en este trabajo sobre el delirio no buscar en él ni la deficiencia ni la alteración, sino más bien lo que hay en él de proceso transformador lleno de sentido. Con el objeto de profundizar en el concepto de "transformación", recurre a un soneto de R. M. Rilke, y para comprender las semejanzas y diferencias entre la experiencia religiosa psicótica y la normal, se apoya en ejemplos clínicos y en algunos textos religiosos y mitológicos. De lo anterior se desprende -entre otras características positivas del proceso psicótico- que estos enfermos tienen una capacidad de tolerar la proximidad de lo divino que los normales han perdido ya hace mucho tiempo (AU)

El papel de la fenomenología en la terapéutica psiquiátrica con especial referencia a la esquizofrenia / The role of phenomenology in psychiatric therapeutics with special reference to schizophrenia

La fenomenología es un método de descripción y, por ende, de conocimiento de realidades complejas. A primera vista no parece haber una relación, entonces, entre este método y la terapéutica. Sin embargo, este nexo existe en al menos dos sentidos. Primero, por que la actitud fenomenológica es fundamental para el correcto diagnóstico de las enfermedades endógenas, esas carecen de un subtrato al que se puede acceder por medio de exámenes de laboratorio o por imágenes. La sensación praecox (Praecox-Gefühl) es sólo un ejemplo de diagnóstico fenomenológico de la esquizofrenia. Existen incluso investigaciones empíricas que demuestran que la mayoría de los psiquiatras emplea en la práctica clínica el diagnóstico atmosferico, sin saber siquiera que éste tiene una fundamentación teórica. En segundo lugar, la fenomenología está vinculada al tratamiento de la esquizofrenia a travéz de ciertas formas de psicoterapia que han nacido a su amparo, como el caso de la psicoterapia existencial (Binswanger) y de la hermenéutica (Blankenburg). Más que una revisión de los aportes de las psicoterapias mencionadas, el autor se propone mostrar en este trabajo de qué manera la actitud fenomenológica puede traducir en formas prácticas y originales de ayuda al paciente esquizofrénico. Es el caso, por ejemplo, del carácter terapéutico que puede tener la primera entrevista, el alivio que puede significar para el paciente una actitud del terapeuta que esté libre de prejuicios como la distinción entre normal y anormal, cuerdo o loco, real o irreal, etc. Y por último, la asunción de una perspectiva dialéctica que permita descubrir en cada paciente lo positivo de su negatividad

Etica y psiquiatria: aspectos de la praxis cotidiana / Ethical aspects of dayly medical practice

El artículo plantea diversos aspectos éticos relevantes para la práctica médica en general y para la psiquiatría en particular, con especial énfasis en la psicoterapia. La preocupación por el momento ético del acto médico data de la cultura griega antigua, cuando la revolución hipocrática transformó el ejercicio médico de magia en ciencia. Una ciencia indisolublemente ligada con arte cuando se alude al ser humano, su subjetividad, su experiencia vital y su entorno. A través de un recorrido por el mundo helenístico, principalmente el pensamiento platónico, de algunas concepciones cristianas y de diversos aspectos vigentes en la actualidad se tratan "problemas" relacionados con el diagnóstico psiquiátrico, la farmacoterapia y la psicoterapia. Finalmente se propone una estrategia a seguir, que depende en parte del marco teórico elegido, y en parte de la patología que aqueja al paciente

La muerte y el suicidio en la poesía de Rainer María Rilke / The death and the suicide in the poetry of Rainer María Rilke

El suicidio sólo se puede comprender desde una reflexión previa sobre la muerte. A propósito de algunos textos de Hegel, Goethey Heidegger, el autor recuerda la concepción de la muerte no sólo como parte de la vida, sino como lo que le da sentido. Una idea análoga, aunque expresada de un modo muy original, es la que sostiene el poeta Rainer María Rilke en una carta a su editor en polaco, W. Hulewicz, del 13 de noviembre de 1925. El autor intenta investigar más en profundidad el pensamiento del poeta respecto a la muerte, a través de un análisis de la Octava, Novena y Décima Elegías del Duino (1922), poesías en las cuales el poeta desarrolla su concepto de la ômuerte propiaõ, anunciado en su novela Los Cuadernos de Malte (1910). Para él la vida misma consiste en ôaprender a morirõ, en preparar con tiempo ôla obra maestra de una muerte noble..., de una muerte consumada, feliz y entusiasta, como sólo los santos supieron concebirlaõ. La pregunta es entonces qué puede pasar para que alguien no espere su muerte propia y destruya con su acto suicida la armonía de la vida y de la muerte. La respuesta la da el poeta en el Réquiem para Wolf von Kalckreuth (1908). El suicida no reconoce en la tierra la posibilidad de la alegría, como la que a veces se esconde detrás de los dolores. En segundo lugar, el suicida se apresura a dar a la vida y a la muerte una interpretación definitiva, sin esperar que en el camino se nos devele el sentido de la existencia. Por último, el joven suicida de Rilke, que era un poeta, no dejó madurar su obra, quizás porque no comprendió cuál era la esencia de la poesía: que a través de ella el poeta se transforme en las palabras que eternizan las cosas.

Biología, enfermedad y salud mental: salud mental y diaita (la dieta griega) / Biology, disease and mental health: mental health and diaita (the greek diet)

La revisión de los conceptos de salud y enfermedad en la Grecia Clásica permite establecer la importancia que tiene para el cultivo de la salud el concepto de diaita (dieta), la que por cierto es mucho más que un régimen alimenticio. Las distintas dietas empleadas por los griegos derivaban de determinados conocimientos que se expresaban en normas, en nomoi. Ahora bien, si los nomoi y la dieta estaban de acuerdo con la ley divina, el hombre no solo podía mantener su salud, sino también desarrollar todas su potencialidades. Pero la dieta no sólo tenía que ver con la salud del cuerpo, sino también con la del alma, dada su estrecha relación con la educación o paideia. Según Hipócrates, cualquier ciudadano podía alcanzar la areté, la virtud, a través de la prácticade la dieta adecuada, algo que en la Grecia arcaica estaba reservado sólo a los aristocratas. La dieta consistía en el respeto a los ritmos biológicos fundamentales, en una vida en armonia con la naturaleza y con los dioses y en la búsqueda de la proporción entre trabajo y descanso, actividad física y espiritual, preocupación por sí mismo y por el otro, etc. Llama la atención el hecho que en la sociedad tecnológico-industrial, junto con el alejamiento del hombre respecto a la naturaleza y a sus ritmos, se haya producido un aumento impresionante de dos patólogias: la enfermedad coronaria y la depresión mayor, puesto que ambas enfermedades aparecen vinculadas a personalidades típicas, el Tipo A y el Typus Melancholicus, respectivamente, y éstas representan distintas formas de exageración de la ideología imperante, con la sobrevaloración del rendimiento, la competitividad y el abandono progresivo de todo vínculo con la dimensión trascendente, vale decir, dos formas diferentes de malograr la diatia, que los griegos tan tempranamente reconocieran como una condición sine qua non de la verdadera salud

Measurement errors of a short self-assessed test on alcoholism

The Munich Alcoholism Test (MALT) was applied in several European (Germany and Spain) and Hispano-american (Ecuador, Mexico, Peru and Chile) countries, using an items-reduced-desing. Four culture-free items were detected, which yielded a short and self-assessed Cross-Cultural Index of Alcoholism. The Hispano-american samples used in a simulacrum, have empirically demonstrated that this instrument measures alcoholism and has an adequate degree of accuracy in the measurement

Personalidad y enfermedades afectivas / Personality and affective diseases

El tema de la relación entre la personalidad y las enfermedades afectivas (depresión mayor, ciclotimia y las distintas formas de bipolaridad) ha sido revisado extensamente en los últimos años por los autores norteamericanos H.S. Akiskal (1983) y Katherine Phillips et al.(1990). Los resultados de ambas revisiones son al menos confusos, puesto que muestran una enorme gama de formas distintas de relacionarse la personalidad y el cuadro afectivo ( ninguna de ellas esencial). Esto contradice en cierto modo la experiencia clínica cotidiana de que los depresivos monopolares son personas con características más o menos comunes y propias y lo mismo valdría para los bipolares. El autor plantea que las razones de la confusión reinante, así como de los resultados contradictorios obtenidos a este respecto en investigaciones empíricas, se podría deber a la falta de definiciones adecuadas (y no sólo estrictas) tanto del síndrome depresivo como del trastorno de personalidad. Lo primero intenta demostrarlo a través de las ventajas que tendría una fenomenología del síndrome depresivo sobre las definiciones operacionales. Lo segundo, a través de la teoría de los tipos ideales de Max Weber, que parece mucho más adecuada para la conceptualización de los trastornos de personalidad que la mera enumeración de rasgos obtenidos estadísticamente. Ejemplos de tipos ideales demostrados luego por investigaciones empíricas (von Zerssen y col., 1969, 1982, 1988) serían el typus melancholicus de Tellenbach (1961) y el typus manicus de von Zerssen (1988). Por último, se dan a conocer los interesantes resultados de una investigación sobre el tema realizada en Chile por Anneliese Dörr (1991) y dirirgida por el autor y en la cual los planteamientos de los mencionados autores alemanes sobre las relaciones entre personalidad y enfermedad afectiva se vieron ampliamente confirmados