100 Year Celebration of Karl Jaspers' General Psychopatholgy

1. Queen’s University
Department of Psychiatry
GRAND ROUNDS
Friday, October 18, 2013
Providence Care – Mental Health Services
Amphitheatre
8:00 - 9:00
Gregor y J. Walt ers, PhD
Professor of Philosophy
Saint-Paul University, Ottawa
C. Cabr era, LMS, MSc, MRC Psych.
Associate Professor
Department of Psychiatry
Queen’s University
“Empirical and Interpretive Psychiatry
Today- Looking Back, Looking Ahead:
A Centennial Celebration in Honour of
Karl Jaspers's General
Psychopathology”
These rounds are Royal College, Maintenance of Certification Accredited
Learning Objectives on reverse
Upcoming Rounds – October 25, 2013 at PC-MHS
Nov. 1, 8, 18, 22 & 29 at HDH
Coffee & Refreshments will be available prior to rounds

2. Learning Objectives
1. Jaspersian Echoes: Briefly survey Jaspers’s scholarly reception
in North American psychiatry.
2. Looking Back: briefly identify the definition and tasks of
phenomenology, outline, levels of medical practice in
psychotherapy, and “complex unities,” “concrete enigmata,” and
“the problem of a unified whole” in relation to understanding the
human being as a whole.
3. Mental Health Stigma-Looking Ahead: briefly identify the
problem of mental health stigma, some ethical considerations, and
the contemporary relevance of Jaspers’s philosophy to emerging
cognitive, emotional and physical enhancement technologies and
Transhumanist philosophy.

4. I. Jaspersian
Echoes

8. Jaspers’s Echoes in North America

9. Echoes- DSM & Death of Phenomenology

10. Echoes- DSM-IV,ICD as reified categories

11. “Antagonomia” &
“Idiomania”

12. Echoes- Perceptual Field Deficit

13. Echoes- Time Consciousness

14. Echoes- ‘Joint Reference’ Overcoming Biomedical Bias

15. Depressive Realism, the Cognitive Distortion Model
and Existential Psychotherapeutic Methods

16. Echoes- Diagnosis & Ideal Types

17. Echoes- Perspectivism & Methods

18. II. Looking
Back

20. General Psychopathology

21. The General Psychopathology

22. “Phenomenology” Defined (1912)
“….Illustrative representation of individual experience
(anschauliche Vergegenwärtigung individuellen seelischen
Erlebens); an empirical method designed to define
experienced mental states– i.e., subjective phenomena –
within the narrowest possible confines; to distinguish
between them; and to separate them terminologically.”
Phenomenology accomplishes all this, “depending on the
individual case, by the enumeration of a number of
outward characteristics of the mental state, of the
conditions under which it occurs, through vivid, illustrious
comparisons and symbolizations, through a kind of
suggestive representation,” which is based on empathy and
which is supposed to enable the reader of a
phenomenological description empathically to perceive the
phenomenon described.”
JASPERS, K. “Die phänomenologische Forschundsrichtung in der Psychopathologie” (1912) Zeitschrift für die gesamte Neurologie und
Pscyhiatrie, No. 9, 1912, 391ff., translated in Ludwig B. Lefebre, “The Psychology of Karl Jaspers,” in P.A. Schillp, ed., The Philosophy
of Karl Jaspers, 473

23. Tasks of “Phenomenology” (1913)
Provide concrete descriptions of
individual psychic states and present
them for observation.
Review the inter-relations of these,
delineates them, differentiates them,
and creates suitable terminology.
Patients’ self-descriptions are the chief
help.
Close contemplation of an individual
case teaches phenomena common to
countless others.

24. What Conditions Determine Cognition in the Psychiatric Realm?
Erklärende Psychologie Part Three:
Causal Connections of Psychic Life
 Cause-Effect Relationships; Causal
Scientific [Statistical] Explanation
 Objective causal relationships are
“always observed from the outside
only.” Allgemeine Psychopathologie,
24
 “Ascertainment of empirically
existing cause and effect
relationships which in themselves
cannot be understood but are
recognized as necessary.”
 Example: Recognition of a
connection between the
deterioration of performance, on the
one hand, and fatigue on the other
hand.
Verstehende Psychologie Part Two:
Meaningful Psychic Connections
 Verstehen- “perception of
mental phenomenon from
within.”
 Knowledge based on the
intuitional comprehension of
“understandable” processes.
 Comprehension of
meaningful psychological
relations demonstrating an
“inner causality” as opposed
to the “outer [genuine]
causality” discovered by
explanation.

26. The Link With Different Levels of
General Medical Therapy
(a) Doctor applies technical knowledge of cause and
effect and through mechanical and chemical
means repairs the disturbed connections in the
apparatus of life.
(b) Submits the living being to certain conditions, of
diet, environment, rest or exertion, training [cf.
CBT]…facilitates the living being as a whole to help
itself.
(c) Addresses herself to patient as a rational
being…body-psyche unity (neurological, hormonal
and morphological unitary structures)

27. The Link With Different Levels of General Medical Therapy
“…Once the individual has turned into an object,
she can be treated by technical means, nursing
care and skill, but the individual as herself can
only discover herself through the mutual sharing
of destinies.” (cf. self-concealment vs. revelation)
(e) The ultimate thing in the doctor-patient
relationship is existential communication; doctor
and patient are “fellow-travellers in destiny;”
psychiatrist is neither “pure technician” nor
“pure authority.” “There is no final solution.” Karl
Jaspers, The Nature of Psychotherapy, p.18.

28. Summation
“Thus in therapy the widest polarities lie in
whether the doctor turns to what can be
discovered by science, that is, to the biological
event, or whether he turns to the freedom of
man. A mistake is made about the whole of
human life, should the doctor in looking at
persons let them be submerged in the biological
event; so too should he convert human freedom
into that sort of being which, like nature, is
empirically there and can be used technically as
an instrument of therapy. Life I can treat, but to
freedom, I can only appeal. (Karl Jaspers, The Nature of
Pyschotherapy, 20.

29. Part Six. The Human Being as a Whole

30. (c.) Philosophy in Psychopathology
“If anyone thinks she can exclude
philosophy and leave it aside as useless
she will eventually be defeated by it in
some obscure form or other. From this
springs the bad philosophy in
psychopathological studies. Only she who
knows and is in possession of her facts
can keep science pure and at the same
time in touch with individual human life
which finds its expression in philosophy.”
(GP, Vol.II, 770)

31. Part Six.“The Human Being as a Whole”
• Scientific obligation to integrate
philosophical anthropology with empirical
facts of scientific psychopathology.
• Particular scientific facts must always
square with the unified whole to which
they belong.
• Various wholes prove to be “complex
unities” for somatic and psychic
investigation.

32. (c) The “Complex Unities” in retrospect and the problem
of a unified whole (GP, 750ff)
I. The momentary whole in which
experienced phenomena occurred
was the state of consciousness.
II. The whole of the meaningful
connections was the personality.
III. The whole of the causal connections
was comprised in the several
theories.

33. c. The complex unities in retrospect
and the problem of a unified whole
IV. The complex clinical unities were the
ideas: of the disease entity, of the Eidos,
(Constitution, etc.); of the Bios (the
individual life – as the whole of the person’s
life in time).
V. The communal and historical whole of
the individual appeared as the state of his
society, the objective culture, the historical
epoch, the communal spirit as displayed in
peoples, states and in the masses. (GP, 750ff)

34. False Conversions of Complex Unities into Absolutes
“The momentary whole tends to be taken for the
ultimate whole: the psyche is consciousness and nothing
else; the performance as a whole is the only objectivity,
the only object for science; the body-psyche unity is
reality itself; milieu and culture are absolutes to partake
in which is psychic reality; personality is the essence of
the psyche, its meaningfulness is its Being; theories
grasp the true reality; causal connections are the
substance of things, the body is everything, the psyche is
only a transit-station for hereditary connections;
clinical reality consists of only disease entities,
constitutions and the life history as a unit; the
individual is a function of society and history.” (GP, 750 –
751)

35. (d) The concrete enigmata in retrospect
• Constitution
• Limits of Genetic Research
• Performances
• Limitation of understanding by
biological events and by Existence
itself
• The unity of an individual life (the
Bios) and Chance [Luck]
(Jaspers, GP II, 752-754)

36. (d) The concrete enigmata in retrospect
• Constitution (an insoluble problem)
• Limits of Genetic Research
• Performances
• Limitation of understanding by biological events and by
Existence itself
• The unity of an individual life (the Bios)
Insoluble problems as a whole reduced to abstract
principles:
• ‘Endlessness’
• ‘Individuality’
• ‘That which Encompasses all things’

37. The Encompassing Self
• Ergo, psychopathological knowledge placed in
suspension [sic] at the boundaries of our
knowing vis-a-vis the complex unities, the
concrete enigmata, and “the Encompassing
Self.”
• The GP anticipates the philosophical idea of the
Encompassing: Subject-Being (Body, Intellect,
Spirit/Mind (Geist), ‘possible Exiztenz’);
Object-Being (World and Transcendence);
non-reductionism of any one mode of human
being.

38. Source: Nature Reviews| Neuroscience
Vol.14, May 2013, 365-375.

39. III. Mental
Healh StigmaLooking Ahead

40. Søren Kierkegaard
(1813–1855)
“Once you
label me,
you negate
me.”

41. • “Mark” or “Attribute;” reduces the
•
•
•
•
•
other from “whole and usual” to
“tainted and discounted;” “Less
than fully human.”
“Abominations of body” (Physical
deformities)
“Character blemishes” (Mental
illness, addictions, government aid)
“Tribal Identities” (Race, gender,
religion)
Stigma enacted in social
interaction; Exclusion from full
participation in society; Effects on
identity are not Static
Ebb and flow with “moral career”
and larger societal context

42. Stigma in Mental Health
Stigma“co-occurrence of
its components:”
 Labeling
 Stereotyping
 Separation
 Status loss
 Discrimination
 Power
exercised

43. Public Stigma of Mental Illness

44. Stigma in Mental Health

45. Opening Minds: Anti-stigma,
Anti-discrimination Program (2011)

46. Stigma in Mental Health

47. Prevalence of Personal Stigma Reported by
(7% of sample; n >10,000) respondents treated
for emotional or mental health problem
Survey Item
(Self-reported impact on):
Weighted %
Family relationships
32.0%
Romantic life
30.%
Work or school life
27.5%
Financial situation
25.0%
Housing situation
18.0%
Source: Paradigms Lost: Fighting Stigma
and the Lessons Learned. Ed. Stuart, H.,
Arboleda-Flórez, J., Sartorius, N. OUP,
p.10.

48. Changing Directions, Changing Lives:
The Mental Health Strategy for Canada

49. Mental Health Stigma: Ethical Considerations
UN Convention on the Rights of Persons
with Disabilities): Access to treatment of
mental disorders a human right.
The Principle of Human Rights
"Act in accord with the generic rights of your
recipients as well as of yourself." (Gewirth, 1996,19)
• Generic rights are rights to the generic
features of action-- freedom and wellbeing-- which constitute the necessary
conditions of action.

50. Mental Health Stigma: Ethical Considerations
• Stigma violates generic rights to freedom and
well-being
• “Well-being consists in having the various
substantive conditions and abilities that are
proximately required either for acting at all or
for having general chances of success in
achieving one’s purposes through one’s
actions.” (cf. Social Determinants of Health)
• 3 Levels of Well-being: Basic, Nonsubtractive,
Additive

52. What is Transhumanist Philosophy?
Transhumanism is a contemporary
life philosophy, a global cultural and
intellectual movement that promotes
“an interdisciplinary approach to
understanding and evaluating the
opportunities for enhancing the
human condition and the human
organism opened up by the
advancement of technology.” (Max
More, 2013)

53. Transhumanists
 Seek radical Extension of Human
Life ‘health-span’
Eradication of disease; elimination
of suffering; overcoming the “genetic
lottery.”
Enhancement of human
intellectual, physical, and emotional
capacities by means of
psychopharmaceuticals, genetics,
molecular nanotechnology, artificial

54. Therapy vs. Enhancement?
Transhumanists aim not so much to cure
disease, but “reach beyond” health
 Lift themselves above the norm
 “one-sided triumph of willfulness over
giftedness, of dominion over reverence, of
molding over beholding?” (Michael Sandel 2012, 94).
Is there “Wisdom in repugnance?” cf.
Procreative liberty, Human Cloning? (Leon Kass,
2013)

55. “Psychopathologie”
“The belief that it was possible to develop methods
which would enable us to comprehend man as a
whole (as to constitution, character, body-type, and
disease-entity) persisted, in ever new guises. Despite
the fact that, within limits, all of them were fruitful,
the supposed totality every time proved to be a
totality within the one comprehensive totality of
being human, never this totality itself. For the totality
of man lies way beyond any conceivable
objectifiability. He is incompletable both as a beingfor-himself and as an object of cognition. He remains,
so to speak, "open." Man is always more than what
he knows, or can know, about himself.”
Karl Jaspers, “Philosophical Autobiography,” in P.A. Schillp, ed., The Philosophy of Karl Jaspers, 13.

56. “Life I can
treat,
but to Freedom
I can only
appeal.”
Karl Jaspers,
The Nature of Psychotherapy:
A Critical Appraisal (The University of Chicago
Press, 1965 [1964]), 20.