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Original Paper

Disturbances of Embodiment as Core Phenomena of Depression in Clinical Practice

Doerr-Zegers O.a, c · Irarrázaval L.a, e · Mundt A.d · Palette V.b, f

Author affiliations

aCenter for Studies on Phenomenology and Psychiatry, Faculty of Medicine, and bInstitute of Humanities, Universidad Diego Portales, cAcademic Unit of the University of Chile at the General Psychiatric Hospital, and dMedical Faculties, Universidad San Sebastián, Universidad Diego Portales and Universidad de Chile, Santiago, Chile; eSection Phenomenological Psychopathology and Psychotherapy, Psychiatric Department, University Clinic Heidelberg, Heidelberg, Germany; fArchives Husserl, CNRS/Ecole Normale Supérieure, Paris, France

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Psychopathology 2017;50:273-281

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 13, 2016
Accepted: May 26, 2017
Published online: August 09, 2017
Issue release date: September 2017

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: https://www.karger.com/PSP

Abstract

This paper proposes a phenomenological approach to the diagnosis of depression, with the aim of overcoming the broadness and nonspecificity of the concept of major depressive disorder (MDD) in current systems of diagnostic classification of mental disorders. Firstly, we outline the methodological limitations of the current classification systems for the diagnosis of MDD. Secondly, we offer a conceptual differentiation between a “symptomatological” versus a “phenomenological” diagnosis of depression. Thirdly, we propose characteristic “disturbances of embodiment” as the fundamental phenomena of “core depression”, which manifest themselves in 3 dimensions: embodied self, embodied intentionality, and embodied time. A more useful diagnosis of depression may be achieved by describing the phenomena that constitute a core depression, in order to avoid the overdiagnosis of MDD and its negative consequences in clinical practice.

© 2017 S. Karger AG, Basel


References

  1. World Health Organization: The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, World Health Organization, 2012.
  2. Ministerio de Salud (Minsal): Informe final estudio de carga de enfermedad y carga atribuible. Santiago, Minsal, 2007.
  3. Vicente PB, Rioseco SP, Saldivia BS, Kohn R, Torres PS: Estudio chileno de prevalencia de patología psiquiátrica (DSM-III-R/CIDI) (ECPP). Rev Med Chile 2002;130:527-536.
  4. Pfeiffer WM: Die Symptomatik der Depression in transkultureller Sicht; in Hippius H, Selbach H (eds): Das depressive Syndrom. München/Berlin/Wien, Urban & Schwarzenberg, 1968, pp 151-167.
  5. Tellenbach H: Melancholie, ed 4. Berlin/Heidelberg/New York, Springer, 1983.
  6. Lehmann HE: Epidemiology of depressive disorders; in Revie (ed): Depression in the 70s: Modern Theory and Research. Princeton, Excerpta Medica, 1971, pp 21-31.
  7. Doerr-Zegers O, Enríquez G, Jara C: Del análisis clínico-estadístico del síndrome depressivo a una comprensión del fenómeno de la depressividad en su contexto etiopatogénico. Rev Chil Neuro-Psiquiat 1971;10:17-39.
  8. Haslam N, Beck AT: Subtyping major depression: a taxometric analysis. J Abnorm Psychol 1994;103:686-692.
  9. Ambrosini P, Bennett D, Cleland CM, Haslam N: Taxonicity of adolescent melancholia: a categorical or dimensional construct? J Psychiatr Res 2002;36:247-256.
  10. Grove WM, Andreasen NC, Young M, Endicott J, Keller MB, Hirschfeld RMA, Reich T: Isolation and characterization of a nuclear depressive syndrome. Psychol Med 1987;17:471-484.
  11. Harris M, Farquhar F, Healy D, LeNoury J, Baker D, Whitaker C, Linden S, Green P, Roberts AP: The incidence and prevalence of admissions for melancholia in two cohorts (1875-1924 and 1995-2005). J Affect Disord 2011;134:45-51.
  12. Parker G: A case for reprising and redefining melancholia. Can J Psychiatry 2013;58:183-189.
  13. Healy D: Melancholia: past and present. Can J Psychiatry 2013;58:190-194.
  14. Parker G, McCraw S, Blanch B, Hadzi-Pavlovic D, Synnott H, Rees AM: Discriminating melancholic and non-melancholic depression by prototypic clinical features. J Affect Disord 2013;144:199-207.
  15. Parker G: Through a glass darkly: the disutility of the DSM nosology of depressive disorders. Can J Psychiatry 2006;51:879-886.
  16. Cole J, Mcguffin P, Farmer AE: The classification of depression: are we still confused? Br J Psychiatry 2008;192:83-85.
  17. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5: DSM-5. Washington, American Psychiatric Publishing, 2013.
  18. Ghaemi SN, Voehringer P: The heterogeneity of depression: an old debate renewed. Acta Psychiatr Scand 2011;124:497.
  19. Ghaemi SN, Voehringer P, Whitham EA: Antidepressants from a public health perspective: re-examining effectiveness, suicide, and carcinogenicity. Acta Psychiatr Scand 2013;127:89-93.
  20. Cosgrove L, Shi L, Creasey DE, Anaya-McKivergan M, Myers JA, Huybrechts KF: Antidepressants and breast and ovarian cancer risk: a review of the literature and researchers' financial associations with industry. PLoS One 2011;6:e18210.
  21. Sternbach H: Are antidepressants carcinogenic? A review of preclinical and clinical studies. J Clin Psychiatry 2003;64:1153-1162.
  22. Doerr-Zegers O: Análisis fenomenológico de la depresividad en la melancolía y en la epilepsia. Actas Luso Esp Neurol Psiquiatr Cienc Afines 1979;7:291-304.
  23. Doerr-Zegers O: Über melancholische und epileptische Depressivität; in Tellenbach H (ed): Psychiatrie als geistige Medizin. München, Verlag für Angewandte Wissenschaften, 1987, pp 90-96.
  24. Doerr-Zegers O: Depresión, endogenidad y corporalidad. Rev Neuro-Psiquiatría 1992;55:237-253.
  25. Doerr-Zegers O: Fenomenología de la corporalidad depresiva. Salud Ment 1993;16:22-30.
  26. Doerr-Zegers O: El cambio de la corporalidad y su importancia para la determinación de un síndrome depresivo fundamental o nuclear. Rev Psiquiatría Fac Med Barna 1993;20:202-212.
  27. Doerr-Zegers O: Psiquiatría antropológica: Contribuciones a una psiquiatría de orientación fenomenológico-antropológica. Santiago de Chile, Editorial Universitaria, 1995.
  28. Doerr-Zegers O: Fenomenología de la corporalidad en las grandes psicosis; in Rovaletti LM (ed): La problemática del tiempo en el pensamiento actual Buenos Aires. Buenos Aires, Oficina de Publicaciones Universidad de Buenos Aires, 1996, pp 303-314.
  29. Doerr-Zegers O: Fenomenología de la corporalidad en la depresión delirante. Salud Men 2002;25:1-9.
  30. Doerr-Zegers O, Tellenbach H: Differentialphänomenologie des depressiven Syndroms. Nervenarzt 1980;51:113-118.
  31. Kraepelin E: Einführung in die Psychiatrische Klinik. Leipzig, Johann Ambrosius Barth, 1916, p 359.
  32. Bleuler E: Lehrbuch der Psychiatrie (umgearbeitet von Manfred Bleuler), ed 13. Berlin/Göttingen/Heidelberg, Springer, 1975.
  33. Schneider K: Psychopathic personalities, ed 9 (transl. by Hamilton MW). London, Cassel, 1958.
  34. Fuchs T: Leibliche Kommunikation und ihre Störungen. Z Klin Psychol Psych 1996;44:415-428.
  35. Fuchs T: Das Gedächtnis des Leibes. Phänomenologische Forschungen 2000;5:71-89.
  36. Fuchs T: Melancholia as a desynchronization. Towards a psychopathology of interpersonal time. Psychopathology 2001,34:179-186.
  37. Fuchs T: The challenge of neuroscience: psychiatry and phenomenology today. Psychopathology 2002;35:319-326.
  38. Fuchs T: Corporealized and disembodied minds. A phenomenological view of the body in melancholia and schizophrenia. Philos Psychiatry Psychol 2005;12:95-107.
  39. Fuchs T: Depression, intercorporeality and interaffectivity. J Conscious Stud 2013;20:219-238.
  40. Fuchs T: Psychopathology of depression and mania: symptoms, phenomena and syndromes. J Psychopathol 2014;20:404-413.
  41. Fuchs T, Schlimme JA: Embodiment and psychopathology: a phenomenological perspective. Curr Opin Psychiatry 2009;22:570-575.
  42. Stanghellini G: Disembodied spirits and deanimated bodies: the psychopathology of common sense. Oxford, Oxford University Press, 2004.
  43. Ratcliffe M: Feelings of being. Phenomenology, psychiatry and the sense of reality. Oxford, Oxford University Press, 2008.
  44. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J: An international study of the relation between somatic symptoms and depression. N Engl J Med 1999;341:658-659.
  45. Denninger JW, Papakostas GI, Mahal Y, Merens W, Alpert JE, Nierenberg AA, Yeung A, Fava M: Somatic symptoms in outpatients with major depressive disorder treated with fluoxetine. Psychosomatics 2006;47:348-352.
  46. Trivedi MH: The link between depression and physical symptoms. Prim Care Companion J Clin Psychiatry 2004;6:12-16.
  47. Lépine JP, Briley M: The epidemiology of pain in depression. Hum Psychopharmacol 2004;19:3-7.
  48. Beverly K, Shailesh J, Trivedi MH: Depression and pain. Implications for symptomatic presentation and pharmacological treatments. Psychiatry (Edgmont) 2005;2:12-18.
  49. Jaspers K: General Psychopathology (transl. by Hoenig J, Hamilton MW). London, Johns Hopkins University Press, 1997.
  50. Schwartz MA, Wiggins OP: Diagnosis and ideal types: a contribution to psychiatric classification. Compr Psychiatry 1987;28:277-291.
  51. Schwartz MA, Wiggins OP, Norko M: Prototypes, ideal types, and personality disorders: the return to classical psychiatry. J Pers Disord 1989;3:1-9.
  52. Schwartz MA, Wiggins OP, Norko M: Prototypes, ideal types, and personality disorders: the return to classical phenomenology; in Livesley WJ (ed): The DSM-IV Personality Disorders. New York, Guilford Press, 1995, pp 417-432.
  53. Hempel CG: Aspects of scientific explanation and other essays in the philosophy of science. New York, Free Press, 1965.
  54. Gauron EF, Dickinson JK: The influence of seeing the patient first on diagnostic decision making in psychiatry. Am J Psychiatry 1969;126:199-205.
  55. Kendell RE: The role of diagnosis in psychiatry. Oxford, Blackwell, 1975.
  56. Rümke HC: Das Kernsymptom der Schizophrenie und das “Praecox Gefühl.” Zentralbl Gesamte Neurol Psychiatr 1942;102:168-175.
  57. Hamilton M: Rating depressive patients. J Clin Psychiatry 1980;41:21-24.
  58. Merikangas KR, Angst J, Eaton W, Canino G, Rubio-Stipec M, Wacker H, Wittchen HU, Andrade L, Essau C, Whitaker A, Kraemer H, Robins LN, Kupfer DJ: Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. Br J Psychiatry 1996;168:58-67.
  59. Kessler RC: The prevalence of psychiatric comorbidity; in Wetzler S, Sanderson WC (eds): Treatment Strategies for Patients with Psychiatric Comorbidity. New York, John Wiley & Sons, 1997.
  60. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS: The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289:3095-3105.
  61. Heerlein A, Doerr-Zegers O: Transkulturelle Aspekte der depressiven Erkrankungen; in Holm-Hadulla RM, Draguhn A (eds): Die vielen Gesichter der Depression. Heidelberg, Universitätsverlag, 2015.
  62. Regier DA, Kuhl EA, Kupfer DJ: The DSM-5: classification and criteria changes. World Psychiatry 2013;12:92-98.
  63. Dennett D: Consciousness Explained. London, Penguin, 1991.
  64. Husserl E: Erfahrung und Urteil. Hamburg, Meiner, 1939.
  65. Husserl E: Ideen zu einer reinen Phänomenologie und phänomenologischen Philosophie. 1. Den Haag, Martinus Nijhoff, 1950.
  66. Husserl E: Ideen zur einer reinen Phänomenologie und phänomenologischen Philosophie. 2. Den Haag, Martinus Nijhoff, 1952.
  67. Husserl E: Logische Untersuchungen, Den Haag, Martinus Nijhoff, 1975.
  68. Merleau-Ponty M: Phénoménologie de la perception. Paris, Gallimard, 1945.
  69. Gallagher S, Zahavi D: The phenomenological mind, ed 2. New York, Routledge, 2012.
  70. Hofer G: Phänomen und Symptom. Nervenarzt 1954;25:342-344.
  71. Haefner H: Symptom und Diagnose; in Stolze H (ed): Arzt im Raum des Erlebens. München, Lehmann, 1959, pp 29-39.
  72. Blankenburg W: Aus dem phänomenologischen Erkrankungsfeld innerhalb der Psychiatrie (unter Berücksichtigung methodologischer Fragen). Schweizer Archiv Neurol Psychiatrie 1962;90:412-421.
  73. Tatossian A: Symptômes cliniques et structures phénoménologiques. Psychiatries 1978;35:45-52.
  74. Kraus A: How can the phenomenological-anthropological approach contribute to diagnosis and classification in psychiatry?; in Fulford B, Morris K, Sadler JZ, Stanghellini G (eds): Nature and Narrative: An Introduction to the New Philosophy of Psychiatry. Oxford, Oxford University Press, 2003, pp 199-216.
  75. Heidegger M: Sein und Zeit. Tübingen, Max Niemeyer, 1927.
  76. Palette V: Evidence as norm of normativity in perception; in Doyon M, Breyer T (eds): Normativity in Perception, New Directions in Philosophy and Cognitive Science. New York, Palgrave Macmillan, 2015, pp 196-208.
  77. Stumpf C: Über den psychologischen Ursprung der Raumvorstellung. Leipzig, Hirzel, 1873.
  78. Brentano F: Deskriptive Psychologie. Hamburg, Meiner, 1882.
  79. Fuchs T: Phenomenology and psychopathology; in Gallagher S, Schmicking D (eds): Handbook of Phenomenology and the Cognitive Sciences. Dordrecht, Springer, 2010, pp 547-573.
  80. Pallagrosi M, Fonzi L, Picardo A, Biondi M: Assessing clinician's subjective experience during the interaction with patients. Psychopathology 2014;47:111-118.
  81. Marcel G: Etre et Avoir. Paris, Montaigne, 1955.
  82. Zutt J: Aus dem Weg zu einer anthropologischen Psychiatrie. Berlin/Göttingen/Heidelberg, Springer, 1963.
  83. Parnas J, Moeller P, Kircher T, Thalbitzer J, Jannson L, Handest P, Zahavi D: EASE: Examination of anomalous self-experience. Psychopathology 2005;38:236-258.
  84. Irarrázaval L: The lived body in schizophrenia: transition from basic self-disorders to full-blown psychosis. Front Psychiatry 2015;6:9.
  85. Stanghellini G: Embodiment and schizophrenia. World Psychiatry 2009;8:56-59.
  86. Fuchs T: Psychopathologie von Leib und Raum. Phänomenologisch-empirische Untersuchungen zu depressiven und paranoiden Erkrankungen. Darmstadt, Steinkopff, 2000.
  87. Fuchs T: The phenomenology of shame, guilt and the body in body dysmorphic disorder and depression. J Phenomenol Psychol 2002;33:223-243.
  88. Berner P, Gabriel E, Katschnig H, Kieffer W, Koehler K, Lenz G, Simhandl C: Diagnosekriterien für Schizophrene und Affektive Psychosen. Genf, Weltverband für Psychiatrie, 1983.
  89. Plügge H: Wohlbefinden und Missbefinden. Beiträge zu einer Medizinischen Anthropologie. Tübingen, Max Niemayer, 1972.
  90. Binswanger L: Melancholie und Manie. Pfullingen, Neske, 1960.
  91. Mayer-Gross W, Slater E, Roth M: Clinical Psychiatry. London, Baillière, Tindall & Cassell, 1974.
  92. Solomon A, Haaga DA, Arnow BA: Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research. J Nerv Ment Dis 2001;189:498-506.
  93. Hankin BL, Fraley RC, Lahey BB, Waldman ID: Is depression best viewed as a continuum or discrete category? A taxometric analysis of childhood and adolescent depression in a population-based sample. J Abnorm Psychol 2005;114:96-110.
  94. Bowins B, Depression: discrete or continuous? Psychopathology 2015;48:69-78.
  95. Benazzi F: Various forms of depression. Dial Clin Neurosci 2006;8:151-161.
  96. Fuchs T: Subjectivity and intersubjectivity in psychiatric diagnosis. Psychopathology 2010;43:268-274.
  97. von Gebsattel VEF: Prolegomena einer Medizinischen Anthropologie. Berlin/Göttingen/Heidelberg, Springer, 1954.
  98. Straus E: Das Zeiterlebnis in der endogenen Depression und in der psychopatischen Verstimmung. Monatsschr Psychiatrie Neurol 1928;LXVIII:640-656.
  99. Aho K: Depression and embodiment: phenomenological reflections on motility, affectivity, and transcendence. Med Health Care Philos 2014;16:751-759.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 13, 2016
Accepted: May 26, 2017
Published online: August 09, 2017
Issue release date: September 2017

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: https://www.karger.com/PSP


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