Schizophrenia and common sense: study of 3 single cases.

There is new interest in subjective experiences of schizophrenia. This kind of analysis emphasizes the subjective stories of patients, and the methods do not pretend to have the objectivity of science. However, the plausibility and the empathetic resonance of the single case may bring subjective confirmation to the validity of an insight and indicate new directions of research. Following this line, the authors present a study of 3 single cases of 'reflexive' residual type of schizophrenia. The methods for selecting the cases and the philosophical groundings of the concept of 'reflexive schizophrenia' are explained. The analysis of the single cases revealed that (1) schizophrenic persons' cognitive deficit is related to the constitution of common sense; (2) some schizophrenics cope with the cognitive deficit by creating a theoretical corpus of axioms stemming from common sense, namely the 'axioms of everyday life'; (3) this mechanism of coping is described as an inflexible attachment to 'axioms of everydayness', and (4) this attachment to common sense releases the patient from all personal investment of self in the process of anchoring in the living world and, on this basis, allows a relatively solid, although distant, attachment to reality. The nature of deficit in schizophrenia is also discussed by confronting the phenomenological point of view and the neuropsychological, that is the so-called 'theory of mind'.

Psychotic experience and disordered thinking: a reappraisal from new perspectives.

The reports of a person suffering from loose associations and disordered behavior serve as the basis for a phenomenology of some central components of psychotic experience. Especially salient are "the expansion of the horizon of meanings," "the emergence of explicit experiences from implicit ones," and "the reduction of complexity." The phenomenological concepts thus developed supplement recent discoveries in neuroscience and experimental psychopathology. Cognitive neuroscientists have depicted the surface of the brain as a repository of self-organizing cortical maps of mental life. Furthermore, experimental psychopathologists have characterized semantic associative networks in normal experience and in psychosis. The authors conclude by joining the phenomenology of psychotic consciousness with the findings of these neuroscientists and experimental psychopathologists.

Perspectivism and the methods of psychiatry.

In their book, The Perspectives of Psychiatry, Paul R. McHugh and Phillip R. Slavney propose four basic perspectives to undergird and inform the practice of psychiatry. These are the perspectives of diseases, dimensions, behaviors, and life stories. The authors redescribe these four perspectives in terms of their underlying "logics": law-governed causality, comparative and quantitative concepts, teleology, and narrative, respectively. After explicating the general nature of a psychiatric perspective, the authors show how such a perspectivism can resolve disputes concerning the different methods of psychiatry and how it can avoid the shortsightedness of sectarianism.

Typifications. The first step for clinical diagnosis in psychiatry.

Reigning views on psychiatric nosology regard as "too subjective" certain features of diagnosis which respected psychiatrists have reported and several empirical studies have confirmed. We describe two of these persistent "mysteries" of psychiatric nosology: rapid diagnoses and the praecox feeling. We then demystify these mysteries by explicating the workings of "typification" in the diagnostic process. The criteria of disorders which are provided by classification manuals, such as DSM-III, are shown to presuppose such typifications. Psychiatric typification, although a preconceptual skill, can be rendered fully scientific and objective.

Systems and the structuring of meaning: contributions to a biopsychosocial medicine.

The authors discuss the biopsychosocial (systems) model of medicine formulated by George L. Engel. The interaction among systems is explained in terms of selection, negation, and the reduction of the complexity of events. In psychosocial systems, vast possibilities of experience and behavior are selected and negated through structures of meaning. The authors illustrate how meaning organizes the experience and activity of a man suffering a myocardial infarction, a case originally discussed by Engel. The role of meaning in psychosocial systems leads to a discussion of the scientific method for investigating it that is provided by Karl Jaspers' psychology of understanding.