Huber G
Universitäts-Nervenklinik, Bonn, Germany.
Fortschr Neurol Psychiatr. 2002 Aug;70(8):393-402. doi: 10.1055/s-2002-33058.
Proceeding from the considerations of European psychiatrists that trends in the contemporary psychiatry seem to underestimate or even neglect the psychopathological approach, resulting in a threatening loss of clinical-psychiatric competence, this critical review deals with the reasons and arguments, why our discipline does still need the phenomenological PP for diagnostics and therapy, practice and research. Only the PP under discussion is able to meet the demand of clinical psychiatry to provide a reasonably reliable description of symptoms and syndromes, upon which rational diagnosis and adequate prevention and treatment can be based. The overly objectifying psychiatry of Kraepelin has been overcome by the descriptive-analytic and understanding PP in the direction of Jaspers and Schneider, aiming more at the elucidation of the patients' own inner experiences than at the observation of behaviour and expression. It is shown that important concepts, findings and results of the classical and recent psychiatry could be obtained by means of the PP, developed by representatives of the German speaking clinical psychiatry and psychology. PP has to take the lead previous to all other basic sciences, relevant for our discipline, also because it is not a self-contained theory, but an open approach, based on methodological reflection, showing ways for research. If the maxime "phenomenology is prior to genesis and interpretation" is ignored, or, if this PP is confused with and mistaken for philosophical phenomenology, the results of such a procedure must be doubtful. An intense training and thorough adoption of PP, the "phenomenological attitude" of the physician is urgently demanded as well by German speaking as recently also by anglophone psychiatrists. The substantial influence of the "phenomenological attitude" on psychology and sociology of clinical practice, on the atmosphere of a psychiatric hospital and the style and kind of psychiatric research, due to the fact that the psychopathologist can do practical and scientific work only with the patient and in very close relation with the patient, is also meaningful in order to avoid faulty developments. In this connection the dependence of psychiatry of political and sociological conditions and its susceptibility for ideologies is discussed and illustrated by some pertinent examples of the last decades.
基于欧洲精神病学家的考虑,当代精神病学的趋势似乎低估甚至忽视了精神病理学方法,导致临床精神病学能力面临丧失的威胁,这篇批判性综述探讨了我们的学科在诊断、治疗、实践和研究中为何仍然需要现象学的精神病理学方法的原因和论据。只有正在讨论的精神病理学方法能够满足临床精神病学的需求,即提供对症状和综合征的合理可靠描述,在此基础上才能进行合理诊断以及充分的预防和治疗。克雷佩林过于客观化的精神病学已被朝着雅斯贝尔斯和施奈德方向发展的描述性 - 分析性和理解性精神病理学方法所克服,这种方法更侧重于阐明患者自身的内心体验,而非观察行为和表现。研究表明,德语区临床精神病学和心理学代表所发展的精神病理学方法能够得出经典和当代精神病学的重要概念、发现和结果。精神病理学方法必须在所有与我们学科相关的其他基础科学之前占据主导地位,还因为它不是一个自成体系的理论,而是一种基于方法论反思的开放方法,为研究指明方向。如果忽略“现象学先于发生学和解释”这一准则,或者如果这种精神病理学方法与哲学现象学混淆并被误认,那么这样做的结果必然令人怀疑。无论是德语区的精神病学家还是最近英语区的精神病学家,都迫切要求医生进行强化训练并全面采用精神病理学方法,即“现象学态度”。“现象学态度”对临床实践的心理学和社会学、精神病医院的氛围以及精神病学研究的风格和类型有着重大影响,因为精神病理学家只有与患者密切合作并建立紧密关系才能开展实践和科研工作,这对于避免错误发展也具有重要意义。在这方面,讨论了精神病学对政治和社会条件的依赖性及其对意识形态的敏感性,并通过过去几十年的一些相关实例进行了说明。