Anthropology of Psychiatry Research Paper

What mental illness is in its various manifestations and which methods of investigation and therapies are appropriate for mentally ill patients from the aspect of their humanity, is also a question of anthropology as a comprehensive framework. A particular anthropology determines object theory to a high degree, that is, how mental illness can become objective, as well as the methodological accessibility of this object in psychiatry. Anthropological assumptions do not only determine norms usually applied in psychiatry to differentiate between mental illness and health but also determine ethics in psychiatry and address the relationship between body and soul and problems of free will and of self-determination. Because psychiatry as a science and therapeutic practice often latently implies an anthropology, by which psychiatry is deeply determined, psychiatry cannot avoid reflecting these premises. Above all, this is valid for the question of the adequacy of its methods for the respective object. A particular anthropology, however, does not only contribute to the development of what in psychiatry can become the object and its methodological accessibility, but it can also even prevent this development. Thus, certain results of research can be enabled, but can also be prevented.

As yet, it has not been sufficiently realized that psychiatry can be restricted in its scientific and therapeutic possibilities by its anthropology and can even be endangered by dogmatic and overgeneralized basic assumptions. Problems of reductionism, however, of nothing-but theories, of the methodological preconditions of experience, are increasingly acknowledged. What Jaspers (1965) said about philosophy is also valid for anthropology. Stressing its significance for psychiatry, it does not only free the inner space for new possibilities of knowledge, but can also open horizons more adequate to a better understanding of the patient. A switching between anthropological and empirical research (Mundt and Spitzer 1999) has decisive significance for innovation and thus for the development of psychopathology as well as of psychiatry in its therapeutic and rehabilitative practice.

Ever since the separation of natural and cultural sciences we have differentiated between anthropology in the sense of natural science and philosophical and cultural anthropology. Whereas scientifical or biological anthropology, identical with physical anthropology or human biology, is concerned with the biological nature of humankind, philosophical anthropology makes statements about our personal or spiritual essence. Cultural anthropology, mostly interchangeable with ethnology, is concerned with the question of which information is given by cultural statements about what is variable and constant in human beings. To what extent is it possible to start with a previously given essence of human beings and in which way does the human being as the ‘nondetermined animal’ (Gehlen 1966) determine what he or she is. This question became one of the main topics of existential philosophy, where this human self-determination became the most important feature of a person’s essence.

Immanuel Kant ([1798] 1978) already differentiated between a physical and a pragmatic anthropology. Whereas the first is concerned with what humans are by nature, the second, identical with philosophical anthropology, asks what they can make of themselves. Kant’s philosophy became important for psychiatry not only because he developed interesting ideas about mental illness, seeing its general features in a loss of communal sense (sensus communis), that is, the loss of the ability of a person to be corrected by others (§ 53, p. 117), but especially because he has influenced psychiatry with respect to his methodology. Showing the dependency of experience on a priori ideas and thus overcoming the traditional splitting of subject and object, Kant’s philosophy ([1781 87] 1965) stood for an opposition of idealism to realism which maintains the independence of the recognizing subject from the object. This opposition has had a constant effect not only on many philosophical schools of thought but also on psychiatry. With his concept of the transcendental subject he paved the way for Husserl’s phenomenology and for existential approaches of philosophy. These new concepts and methods on their part made possible approaches like Daseinsanalyse (existential analysis), existential psychiatry, and cognitive approaches. Because above all in psychoses the comprehension of the world by the experiencing subject has changed, these psychiatric approaches claim a better understanding of the cognitive processes in these patients.

The following authors of a philosophical anthropology have become important for psychiatry: J. G. Herder (1744–1803), emphasizing the human as a being gifted with language; G. W. F. Hegel (1770– 1831) with his historical philosophical critique of anthropology; M. Scheler (1874–1928), the founder of modern anthropology in his work The Place of Man in the Universe; H. Plessner (1892–1985), who speaks of the eccentric position of human beings, who have only to make out of themselves what they are; and A. Gehlen (1904–67) with his determination of humans as deficient beings because of lack of adjustment to their surroundings and reduction of instinct. At the same time an openness to the world corresponds to this lack. For a psychiatry which calls itself anthropological, the following philosophers were above all influential: S. Kierkegaard (1813–55) who initiated the development of existential philosophy; E. Husserl (1859–1938), the main founder of the phenomenological approach in philosophy; M. Heidegger (1889–1976) with his Daseins analytic; J. P. Sartre (1905–80) with existential psychoanalysis; and M. Merleau-Ponty (1908–61) with his phenomenology of the body. But on the other hand there has been an influence of medicine, especially of psychiatry, on philosophical anthropology: here we could mention Heinroth (1773–1843), V. von Weizsacker (1886–1957), and M. Binswanger (1881–1966).

Multiple influences on psychiatry also arose from biological anthropology (including paleoanthropology, human genetics, research on human bodily constitution), from social anthropology and cultural anthropology, from cognitive and evolutional anthropology. Social anthropology and role theory (see Kraus 1980) had a strong impact on the development of social psychiatry and antipsychiatry followed by many psychopathological concepts and therapeutic measures.

Cultural anthropology examining the cultural variation of the human being as well as human constants independent of culture and epoch shows very clearly the double significance of the concept of anthropology already mentioned above. Showing the variability of the actual being and behavior of human beings, at the same time it marks the boundaries of anthropology as a universally valid theory of the essence of humankind. Cultural anthropology has cultivated a special approach of a transcultural or cultural psychiatry which investigates the variability and frequency of symptoms of disturbance entities, nowadays defined in glossaries, as well as of these entities themselves in different cultures. It has also led to the question of whether regarding the classical entities of disturbances like schizophrenia and manic-depressive illness we are actually dealing with entities of natural diseases or if these are entities only coming from concepts of understanding. Transcultural or cross-cultural psychiatry is thus fundamentally involved in the contemporary crisis of nosology in psychiatry.

With the notion of a cognitive anthropology, Emrich (1999) sums up different approaches of a psychological, physiological (Singer 1994, Roth 1994), and philosophical constructivism. In cognitive anthropology the leading idea is the general quality of constructivity ascribed to systems generating consciousness (Roth 1994). The progress of modern evolutional biology in the future could enable a phylogenetic and ontological understanding of mental disturbances.

Heinroth can be looked at as the founder of an anthropological medicine in its true sense in the context of psychiatry, not to be confused with a medical anthropology. Many anthropological approaches in general medicine, especially those of Weizsacker and Wyss, have also had effects on psychiatry.

Janzarik (1988) has presented an approach of his own to anthropological psychiatry. In his structuraldynamic concept he sees psychopathological phenomena in their neurobiological (dynamic) foundation as coherently connected with biographical structurally bound significances.

Under the heading of a phenomenological-anthropological psychiatry, different approaches can be summarized which have a phenomenological method as well as an anthropological orientation in common. These psychiatric approaches of an eidetic phenomenology of essence and a constitution-phenomenology as well as of Dasein and existence analysis relate to different authors of philosophical anthropology in its broader sense such as E. Husserl, M. Heidegger, J. P. Sartre, and M. Merleau-Ponty.

Even if the understanding of phenomenology and phenomenological in these different approaches is not always the same, the notion of phenomenon aims at that ‘which-shows-itself-in-itself’ and as such is different from the notion of the symptom which points to something which does not just show itself directly, namely to the illness underlying it. An approach strongly oriented to the phenomenon enables us to describe the original individual subjective experience as well as the respective life-world of the patient more adequately and differentiated than otherwise possible.

‘Anthropological’ signifies on one hand what is common to all people and on the other hand what in contrast to the animal is specifically human. In the context of anthropological psychiatry with this term the relationship of psychiatric disturbances to basic human structures is meant, as for instance consciousness and subjectivity, intersubjectivity and individuality, history and temporality, freedom, corporality and so on. These approaches not only take into consideration human essence because of ethical or humanistic reasons, but above all of methodological reasons. The aim is to understand psychiatric disturbances as regular variations of these basic structures, that means of human essence itself. This is done not so much to investigate the factual conditions for the development of psychopathological phenomena but to investigate the conditions originating from human essence which made them possible. For instance hallucination can be understood out of the normal act of perception as an uncoupling of spontaneous imaginative acts from a normal interaction with receptivity (Blankenburg 1980a, 1980b).

Binswanger’s (1955) approach with ‘anthropological proportion’ has turned out to be especially fertile in psychiatry. The partly oppositional dimensions of height and breadth in human existence, of self-realization and world-realization, of individuation and relationship to community, of need for continuity and openness to innovation, of tolerance and intolerance of ambiguity, of overidentification and underidentification normally stand in a certain proportion to each other. These proportions are shifted in psychiatric disturbances. Relating to this alteration of the respective proportions some pictures of illness are oppositional. Thus an overidentification with their respective being in melancholics can be opposed to an underidentification in hysterics (Kraus 1996a). Overidentification with social role for example, with environment, etc., can understandably precipitate a melancholic phase in the case of their loss. One speaks of an empty-nest depression if a parent becomes depressed when children leave home. Other examples are a depression in the situation of retirement or of moving house. Hysterics, on the contrary, tend rather not to identify with their respective being or their actual feelings. They are striving for being more and something different than they actually are or to show feelings they have not. The abnormal as well as the normal can in this way be located in a polar field which is structured through ideal norms which oppose one another in a field in which ‘deviations’ from at least two sides are possible, as Blankenburg (1980a) put it. The pathological element can in this way be traced back to healthiness. On the other hand healthiness shows itself as something which always holds the possibility of becoming pathological by an alteration of proportions.

Such a concept of mental disturbances offers a special possibility of identification with the patient in the therapeutic process. Beyond a purely descriptive psychopathology in the sense of Jaspers (1965) it is thus possible to develop a dynamic phenomenology of psychiatric disturbances which has a dialectic character. Jaspers in his subjective psychopathology emphasized the special experience of the patient as opposed to a mere behavioral description in the sense of an objective psychopathology.

An eidetic essence-oriented phenomenology described above goes a step further in trying to grasp the essence of altered experiences and behaviors in a so-called eidetic reduction in the sense of Husserl. In a process of free imaginative variation here one tries to get from a fact to the essence of a fact, from a sensual to a categorical presentation. Categorical presentation means for instance to recognize a particular species of tree in an actual tree, or in different kinds of behavior and experiences of hysterics the element of underidentification, of the pretence of being instead of actual being. Such an eidetic reduction can also be carried out in relation to Heidegger’s notion of ‘In-derWelt-sein’ or Merleau-Ponty s ‘Etre-au-monde’ showing the special relationship of patients to themselves and to the world which is expressed in their experiences and behaviors. A constitutive or transcendental phenomenology in the sense of Husserl is to be differentiated from an eidetic phenomenology. Instead of going from the fact to the essence of a fact as in eidetic phenomenology, constitutive phenomenology examines the constitutive achievements of consciousness, which let us perceive the concrete as it appears to us.

This approach of a constitutive phenomenology and the following philosophy of existence became important for psychiatry because in the perception of psychotic patients—but not only for them—the world and its significances constitute themselves in another way than in healthy people. In psychiatry this has resulted not only in making the experience of objects, for instance classical symptoms, into research topic, but also the preobjective experience, that is, the constitutive processes out of which self and world develop. The preobjective experience is especially important in the intuitive diagnostics, for instance in the so-called precox feeling. Such preobjective experiences are for instance, the spatialization, temporalization, intersubjectivity, and corporality of a patient. Classical symptoms such as delusion, hallucination, phobic anxieties, and obsessive-compulsive symptoms assessed by a psychopathology oriented to the object, turned out to be constructed on such preobjective experiences.

Phenomenology of constitution, as Husserl put it, recently entered into a manifold relationship with cognitive theory and cognitive neuroscience (Wiggins and Spitzer 1997, Gallagher 1997). Varela (1996) even proposed a neurophenomenology. Several authors of the phenomenological-anthropological approach showed how in the contents of delusion and hallucination vs. the psychotic tendency of dissolution of their world, patients try again to give sense to their new world, even if a distorted one (Feldmann and Schmidt-Degenhardt 1997, Muller-Suur 1980, Kraus 1994a).

Husserl’s concept of an intersubjectively constituted life-world became of increasing significance for psychiatry, above all for the understanding of schizophrenic modes of existence (Callieri and Castellani 1981, Blankenburg 1979). People with schizophrenia are characterized by a damaged rootedness in the life-world, connections of significances and relevancies becoming confused, which shows itself in extravagance and oddity but also in the delusions of these patients. Blankenburg (1971) speaks of a lack of natural self-evidence in schizophrenics. Whereas schizophrenics often lack an inner standard which would allow them a behavior appropriate to the social norms, melancholics being too adapted to these norms are too strongly fixed to the common sense and to their life-world (Blankenburg 1979, Stanghellini 1997, Kraus 1996b). This is already shown premorbidly by their hypernomic behavior which is characterized by a lack of distance to normative expectations (Kraus 1996b). This is also shown by the fact that they find their identity above all in their social roles. For this reason they are especially in danger of becoming depressed in the case of the loss of a social role (Kraus 1996b).

Binswanger has developed his existential analysis above all under the influence of Heideggers Dasein analytic in Being and Time (Heidegger 1927), which, against the ontologic intention of the author, Binswanger understood as an anthropology. With existential analysis we are concerned with a hermeneutic of the inner life history which is asked for its underlying individual concept of world which determines the concrete experience and behavior of a person.

Sartre’s (1962) existential psychoanalysis has also contributed to the better understanding of certain pathological modes of existence, such as those of hysterics, melancholics, and patients with anxiety and obsessive-compulsive disorders. In this way we can establish certain existential types which can have an impact on the classification of these disorders (Kraus 1994b).

The phenomenological-anthropological orientation in psychiatry has promoted a series of therapeutic measures, for instance the anthropological-integrative psychotherapy of Wyss (1982) and existential analysis in the sense of Boss (1951) and Condrau (1963). But it has also influenced other therapies.

Summing up we can say that all anthropological approaches in psychiatry have as their aim to bring psychiatric disturbances in contact with the whole of human reality to achieve better understanding of those disturbances in a way that is appropriate to the essence of humankind. Considering anthropological prepositions in this way allows us to reflect the fundamentals of psychiatry in research as well as in therapy by which the phenomenological-anthropological approaches contribute to further development.

Bibliography:

1. Beck A 1970 The core problem in depression: The cognitive triad. In: Massermann J H (ed.) Depression. Theories and Therapies. Grune & Stratton, New York
2. Binswanger L 1955 Vom anthropologischen Sinn der Verstiegenheit. In: Ausgewahlte Vortrage und Aufsatze. Franke, Bern, Germany, Vol. 2, pp. 235–42
3. Binswanger L 1992 Drei Formen missgluckten Daseins. In: Herzog M (ed.) Ludwig Binswangers ausgewahlte Werke. Asanger, Heidelberg, Germany, Vol. 1, pp. 1–443
4. Blankenburg W 1971 Der Verlust der naturlichen Selbst erstandlichkeit. Enke, Stuttgart, Germany
5. Blankenburg W 1979 Phanomenologische Epoche und Psychopathologie. In: Sprondel W M, Grathoff R (eds.) Alfred Schutz und die Idee des Alltags in den Sozialwissenschaften. Enke, Stuttgart, Germany, pp. 125–39
6. Blankenburg W 1980a Anthropologisch orientierte Psychiatrie. In: Peters U W (ed.) Ergebnisse fur die Medizin, 2: Psychiatrie. Die Psychologie des 20. Jahrhunderts. Kindler, Zurich,Vol. 10, pp. 182–97
7. Blankenburg W 1980b Phenomenology and psychopathology. Journal of Phenomenological Psychology 11: 50–78
8. Boss M 1951 Beitrag zur daseinsanalytischen Fundierung des psychiatrischen Denkens. Schweiz Archi es of Neurology and Psychiatry 67(1): 15–19
9. Callieri B, Castellani A 1981 On the psychopathology of the life-world. In: Bello A A (ed.) Analecta Husserliana. Reidel, Dordrecht, Germany, pp. 172–202
10. Condrau G 1963 Daseinsanalytische Psychotherapie. Huter, Bern, Germany
11. Emrich H M, Schiefenhovel W 1999 Philosophische Anthropologie als Grundlagenwissenschaft der Psychiatrie. In: (ed.) Psychiatrie der Gegenwart, 4th edn. Springer, Heidelberg, Germany, Vol. 1
12. Feldmann H, Schmidt-Degenhard M 1997 Strukturale Affinitat des Unverstandlichen im schizophrenen Wahn. Nervenarzt 68: 226–30
13. Gallagher S 1997 Mutual enlightment: Recent phenomenology in cognitive science. Journal of Consciousness Studies 4(3): 195–214
14. Gehlen A 1966 Der Mensch, 8th edn. Athenaum, Frankfurt, Germany
15. Heidegger M 1963 Sein und Zeit. Niemeyer, Tubingen, Germany
16. Janzarik W 1988 Strukturdynamische Grundlagen der Psychiatrie. Enke, Stuttgart, Germany
17. Jaspers K 1965 Allgemeine Psychopathologie. Springer, Berlin
18. Kant J [1781/87] 1965 Critique of Pure Reason (trans. Kemp Smith N). St. Martin’s Press, New York
19. Kant J [1798] 1978 Anthropology (trans. Dowdell V L, rev. and ed. Rudnick H H). Southern Illinois University Press, Carbondale, IL
20. Kraus A 1980 Bedeutung und Rezeption der Rollentheorie in der Psychiatrie. In: Peters U H (ed.) Ergebnisse fur die Medizin, 2: Psychiatrie. Die Psychologie des 20. Jahrhunderts. Kindler, Zurich,Vol. 10
21. Kraus A 1994a Phenomenology of the technical delusion in schizophrenics. Journal of Phenomenological Psychology 25(1): 51–69
22. Kraus A 1994b Phenomenological and criteriological diagnosis: Different or complementary. In: Sadler J, Wiggings O P, Schwartz M (eds.) Philosophical Perspectives on Psychiatric Diagnosis and Classification. Johns Hopkins University Press, Baltimore, MD, pp. 148–62
23. Kraus A 1996a Identitatsbildung Melancholischer und Hysterischer. In: Seidler G H (ed.) Hysterie Heute. Ferdinand Enke, Stuttgart, Germany, pp. 103–10
24. Kraus A 1996b Role performance, identity structure and psychosis in melancholic and manic-depressive patients. In: Mundt C, Goldstein M J, Hahlweg K, Fiedler P (eds.) Interpersonal Factors in the Origin and Course of Affecti e Disorders. Gaskell, London, pp. 31–47
25. Kraus A 1999 Phanomenologisch-anthropologische Psychiatrie. In: Helmchen H, Henn F, Lauter H, Sartorius N (eds.) Grundlagen der Psychiatrie. Springer, Berlin
26. Lang H 1982 Phenomenologisch-anthropologisch orientierte Psychiatrie und Psychologie im franzosischen Sprachraum. In: Eicke D (ed.) Tiefenpsychologie, Vol. 4 Individual-psychologie und Analytische Psychologie. Weinheim, Basel, Switzerland
27. Muller-Suur H 1980 Das Sinn-Problem in der Psychose. Hofgreve, Gottingen, Germany
28. Mundt C, Spitzer M 1999 Psychopathologie heute. In: (ed.) Psychiatrie der Gegenwart, 4th edn. Springer, Heidelberg, Germany, Vol. 1, pp. 4–44
29. Roth G 1994 Gehirn und Geist. In: Schiefenhovel W, Vogel C, Vollmer G, Opolka U (eds.) Vom Affen zum Halbgott. Thieme, Stuttgart, Germany
30. Sartre J P 1962 Das Sein und das Nichts. Rowohlt, Hamburg, Germany
31. Singer W 1994 Gehirn und Bewusstsein. Spektrum, Heidelberg, Germany
32. Stanghellini G 1997 For an anthropology of vulnerability. Psychopathology 30: 1–11
33. Varela F 1996 Neurophenomenology. A methodological remedy for the hard problem. Journal of Consciousness Studies 4: 330–49
34. Wiggins O P, Spitzer M 1997 Cognitive science. In: Embree L, Behnke E A, Carr D et al. (eds.) Encyclopedia of Phenomenology. Kluwer Academic Publishers, Dordrecht, The Netherlands, pp. 101–4
35. Wyss D 1982 Der Kranke vals Partner. Vandenhoeck und Ruprecht, Gottingen, Germany, Vols. 1 and 2