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Book in Focus
The Continuum of Mental Disorders and Unitary Psychosis
History and Perspectives
By Mauricio Viotti Daker
The Continuum of Mental Disorders and Unitary Psychosis: History and Perspectives follows the path from the classification of mental disorders to philosophy and the mind. All that involves the mind embeds an enigmatic complexity, which includes the delimitation of mental disorders. Ideally, these are distinct natural kinds whose specific cause and anatomical or physiological disturbance are known, or are still to be discovered. However, 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 between them and the normal mind, and some scholars even deny their existence.
Conversely, should the way we see them, and 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 do not mean to say that psychiatric disorders or diseases (according to the concept of disease) do not exist. They bring extreme suffering and demand serious health policies, and all possible care. However, the way we classify them might be better approached as more dimensional than categorial. Besides, a dimensional or continuous approach favors the relation between mental disorders and the normality.
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 serves to deepen the reader’s knowledge of these remarkable authors. Through a static-discriminative view of the main content, the reader will be able to access the roots of 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, considering the continuity of psychosis and unitary psychosis. Since the continuum concept in psychiatry is unspoken or implicit, we find it necessary to deal with it further in Chapter 2, which is a pioneering chapter within mental health.
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 Griesinger’s work. Though simplistic from 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 mental disorders, as well as 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 special interest here are his “habitual forms” or the “garment” of mental diseases, as well as 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 is drawn here to his late work, “The manifestation forms of mental disorders.” The chapter argues that 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. Nonetheless, a general continuous disposition for mental disorders is strongly sustainable, which corresponds to the notion of unitary psychosis.
An additional historical investigation in Chapter 9 shows that this disposition to symptom complexes is not solely a matter of psychopathology: 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. As such, embodiment and enactivism play a role in this regard. 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 psychic aspects, we can glimpse an endogenous anthropological structure involved with the mind.
Chapter 10 explores the question of which kind of metaphysical orientation or nature view would better conform or underpin the above. 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. In addition, prominent philosophers sustain that process philosophy can succeed Kantians or neo-Kantians, positivists, and logical empiricists as the most defensible tradition of philosophy. In this philosophical stream, compared to phenomenology, it turns out, for example, that intentionality is more broadly conceived. Intentionality encompasses consciousness initially for Husserl, the relation “Dasein-world” for Heidegger, and the body for Merleau-Ponty. In contrast, for Whitehead, it is in all nature, immersed in panexperientialism or pansubjectivism. In process philosophy (as well as phenomenology), continuity prevails in internal relations rather than the traditional notion of discontinuous enduring substances in external relations, which characterizes materialism.
In addition to 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 and to the thought of 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.
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.
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