Fenomenología de la intersubjetividad en la enfermedad bipolar y en la esquizofrenia
2011; Ramon de la Fuente National Institute of Psychiatry; Volume: 34; Issue: 6 Linguagem: Inglês
ISSN
0185-3325
Autores Tópico(s)Schizophrenia research and treatment
ResumoSUMMARYI. Introduction and clinical observationsOne of the central features of the group of diseases we callschizophrenia is the alteration at the level of interpersonalrelationships. Autism, considered by Bleuler (1911) as one of theprimary symptoms of the disease, and contact difficulty, describedby Minkowski (1927), are two examples of how far this disturbancereaches. But other symptoms of schizophrenia can also be seen fromthe same perspective. Thus, in the paranoid syndrome the otherbecomes so powerful that he can persecute, harass and invade thepatient’s intimacy. Auditory hallucinations can also be conceived ofas a peculiar disturbance of the relationship with an anonymous other.As we showed in a previous work, something similar occurs ininstances of coenesthetic schizophrenia. Thus, one patient, sufferingfrom this form of the disease, said in his diary, «My failure is to lovevery much myself. I have not found yet the way toward the you.» Andlater on he writes: «The world arrives directly to me, there is no distancebetween the world and me. And that is valid both for persons and forthings… It can even happen that in the worst states I consider myselffor moments like the other, whom I am looking at».Walter von Baeyer (1955) defined the characteristics of thisdeformed interpersonal encounter of schizophrenics, although basedon paranoid patients: lack of reciprocity, anonymization andmediatization. In the delusion of being loved, for example, the patientcannot defend himself from loving voices or from coenesthesichallucinations related to the sexual sphere. On the other hand, thatinvading you, who in the beginning has a name, gradually loses hisindividuality and becomes collective. Finally, contact with thehallucinated other is mediated through devices such as radios ortelevision sets.In the case of depression, even though the complaints of thepatients predominantly refer to the feeling of oneself and to bodilychanges, we also observe a deep alteration of the interpersonal sphere.Two different forms of depression can be distinguished: delusionaland not delusional. In the first form, the symptomatology is commandedby delusion (of guilt, ruin or disease) and in the second, by corporalsymptoms, the experience of «not being able to» and the alteration ofbiological rhythms. And additionally, from the perspective of theencounter, both forms of depression have something in common: theprogressive disinterestedness in the other and its replacement by theprevailing subject: the body in one case, delusion in the other.In mania, what first draws attention is euphoria, hyperactivity,flight of ideas and insomnia; however, a deep alteration ofinterpersonality is also apparent. Thus, it is common to observe thatthese patients treat the other with excessive confidence and a loss ofsocial distance up to the extreme of disrespectfulness.II. «Apresentation», immanent temporality and intentionality inthe constitution of Intersubjectivity according to HusserlHow precisely are these three elements of intersubjectivity -apresentation, temporality and intentionality- altered in manic,depressive and schizophrenic psychoses? Each section in the reportthat follows will begin with an introduction explaining Husserl’sunderstanding of these concepts. As the theory of «apresentation» ismore complex and less known, a more detailed exposition of thisconcept will be offered.III. Intersubjectivity and manic psychosisLet us recall Binswanger‘s example of a manic patient who hasabandoned the clinic, goes into a church where a religious service isbeing held, and interrupts the organist’s playing to ask him for lessons.For the layman, the attitude of the patient appears to be inappropriateand incomprehensible. A psychiatrist may speak here of facilitationand of loss of natural inhibitions. But neither of these twointerpretations accounts for what is really occurring. Somatic medicinehas a theory of the organism as a framework within which it can«measure» deviations with respect to the norm; psychiatry is not ableto do this because its basic science is not sufficiently developed. Inour opinion, that place must be occupied, following Binswanger, byphenomenology of intentional consciousness.The organist is present for himself as the flowing of consciouscontents; the sensations coming from his body; and among othersthe ones of his fingers playing the organ. These presentations areaccompanied by the «apresentation» that he is an organist who hasbeen hired to play in the religious service and he shares that same«apresentation» with the community assisting the church. The patient,on the contrary, does not share this «apresentation». For her theorganist is certainly present, playing, but she is not capable of«apresenting» that it is a concert in the framework of a religious service.From Husserl’s theory, explained above, it is inferred that if one failsin the constitution of the alter Ego, the constitution of oneself -ofone’s own Ego- also fails. Binswanger’s patient is unable to«apresentitatively» understand the sense of the organist (in his context),because she can not experience herself «apresentatively» as an Ego.IV. Intersubjectivity and depressive psychosisThe flowing of my internal life is, certainly, inseparable from originaryor primordial temporality, with respect to which objective time or thetime of the clock is only a derivate. And that originary temporality is
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