100 years of psychopathology

By Paolo Fusar-Poli and Giovanni Stanghellini

In 1913, Allgemeine Psychopathologie (General Psychopathology) was published. A guide for young students, doctors and psychologists, it had been completed two years earlier by a 28-year-old German psychiatrist: Karl Jaspers. He aimed to overcome scientific reductionism and establish psychopathology as a new comprehensive science during a period of significant advances in neuroscience. The work had an immediate, dramatic impact and is now a classic in psychiatric literature. Moreover, he established psychopathology as a discipline in its own right — to carefully describe, define, differentiate, and bring order to the chaos of anomalous mental phenomena.The relevance of psychopathology for psychiatry is threefold: it is the common language that allows specialists, belonging to different schools, each one speaking its own jargon, to understand each other; it is the ground for diagnosis and classification in a field where all major conditions are not aetiologically defined disease entities, but exclusively clinically defined syndromes; it makes an indispensable contribution to understanding, a special kind of intelligibility based on the meanings and conditions of possibility of personal experiences.

Psychiatrists need both the personal cultivation and thorough scientific education that psychopathology provides. Its emphasis on human experience, meaningfulness, and valid and reliable methodology to approximate human subjectivity makes it the organon of the humanities in psychiatry, and perhaps in medicine in general. When evidence-based guidelines are still scarce (as is the case, for instance, with early psychoses), psychopathological formation seems to be an indispensable resource for the psychiatrist. For example, it provides the ability to feel an atmosphere and attune to situations that are not yet plainly and unambiguously defined. Moreover, Jaspers drew attention to the active role of the patient. As a self-interpreting agent engaged in a world, the patient interacts with his or her basic disorder and contributes to the shaping of the clinical syndromes.

Jaspers was also active in other fields, such as philosophy, which deeply influenced his work as a psychopathologist. General Psychopathology tried to bring the direct investigation and description of clinical phenomena as subjectively experienced by the patients into the field of clinical psychiatry. Specifically, it changed our understanding of psychosis and schizophrenia. Jaspers’ phenomenological analyses of the pre-delusional atmosphere are still considered an outstanding example of “what it is like” to be a person who is undergoing puzzling and ineffable experiential changes which pave the way to full-blown schizophrenic delusions.

Today, Jaspers work continues to reward and inform psychiatrists. His phenomenological method can help solve ongoing diagnostic concerns by improving the validity of present clinical phenotypes and his approach can be integrated with current neurobiological hypotheses. His person-centered approach in clinical practice is very useful to contemporary psychiatry. In fact, patients are seen as meaning-making, participating in their own healing as empowered agents, and their behaviors not necessarily pathological but potentially adaptive. One hundred years on, we’re still learning from Karl Jaspers.

Paolo Fusar-Poli, MD, PhD, RCPsych is Clinical Senior Lecturer at the Department of Psychosis Studies at the Institute of Psychiatry, London and consultant at the OASIS prodromal team, South London and the Maudsley Foundation NHS Trust. Giovanni Stanghellini, MD and Dr. Phil. honoris causa is full professor of Dynamic Psychology and Psychopathology at Chieti University (Italy) and Associate Professor at Diego Portales University in Santiago (Chile). Schizophrenia Bulletin has a special issue on the 100th anniversary of General Psychopathology.

Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. They have published a special issue devoted to the centenary of its publication (1913-2013), as well as other publications including the volume One Century of Karl Jaspers General Psychopathology to be published by Oxford University Press.

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