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Hebden Water

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This image shows Hebden Water as it flows downhill to Hebden Bridge past Midge Hole. The blue sky and the rim of the valley seen through the interlacing branches of the woodland capture this serene scene within the picture frame. It is remarkable that this scene appears to us as outside of us, when in fact it is within our subjective inner space that is, in our inner world. Another way of putting this is to say that all our perception of the world is seen in our brain but projected back out as a virtual experience that luckily corresponds with the objective & material world. Our virtual world is primary. What is incredible is that this virtual world corresponds exactly with the material world that is its source. And, that jointly with others, by consensus, our private virtual experiences gain objective value and credibility since they are validated by others and also by our successful negotiation of the world about us.

 

How can we tell that our experience of the world is primarily virtual in nature? Well, in cases of the so-called phantom limb, the virtual experience obtrudes and reveals itself. Individuals who have had an amputation, say of a leg, can sometimes continue to feel the leg and foot, and be able to wiggle their toes and suffer cramp and discomfort in the evidently absent leg. The feelings in the absent leg can be compelling and are certainly real and not ‘imagined’, that is, they have all the characteristics of a real experience. In psychiatry, we would say that they have a veridical quality to them. In these cases the hidden aspect of our everyday virtual experiences is revealed. Usually, explanations of phantom limb rely on the fact that representation of the body in the primary sensory cortex remains intact despite the amputation. But, this explanation whilst correct misses the point, namely that all our perception of the world is occurring within our brain and is projected outwards as a virtual world that luckily coincides with the external material world.

 

There are other experiences that confirm this explanation. In Cotard’s syndrome (Jules Cotard 1840-1889), a disorder in which an individual maintains that bodily parts are either missing or dead, or indeed that the whole body has already died, decomposed and disappeared, the subjective virtual experience of the body has been pathologically altered for reasons yet unclear. A woman once said to me that she was ‘already dead and buried’ and another that her midriff was missing such that food fell directly from her chest through the air into her hollow legs, and another that her neck was missing and she had to hold unto her head so that it would not fall off! Against all commonsense, despite visual evidence to the contrary, the compelling experience of an altered virtual image of the body forces the individual to a patently false belief. Phantom limb and Cotard’s syndrome are but mirror images of one another. In one a devitalized body part is experienced as still present and in the other a vital body part is experienced as already dead.

 

What is extraordinary is that there are not more cases of mismatch between the external objective world and the virtual world that the brain projects unto it. Why for example are there no reported cases of mis-timings between the observed and experienced world, so that an arm is felt to move when the observed concrete arm is still at rest? Or more cases of autoscopy?

 

There are the more obvious errors when the brain projects a private virtual experience unto the world in the form of hallucinations. Here, an object is inserted in the perceptual field and this anomaly becomes obvious and is revealed because there is discrepancy between the consensual world that we all share and the false newly created and pathological world.

 

To return to the photo of Hebden Water, it is remarkable that all the beauty that we observe in the world, the glancing rays of sunlight falling on leaves that are shades of indescribable green, and the gurgling of the stream as it flows downhill, the sky and the atmosphere of a place that is all itself and familiar and comforting, that all these elements of the external world are virtual images built up in the brain, given their appropriate valence and value, and then projected out to correspond with the objective world. It is a marvel, indeed a miracle, that the process works most of the time.

Karl Jaspers

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 It is the centenary of Karl Jaspers’ General Psychopathology (Allgemeine Psychopathologie)this year.  Jaspers (1883-1969) was only 30 years old when this influential text was published. Yet, the book has endured and is still in publication.  So, what is it about this book, a textbook of descriptive psychopathology that continues to make it relevant to contemporary psychiatry?

Jaspers had originally intended to study jurisprudence at the University of Freiburg and he completed three semesters before transferring to medicine. He started medicine in Berlin in 1902 before moving to Göttingen in 1903 where he remained for the ensuing 3 years. He then moved to Heidelberg in 1907 to complete his medical studies. At Heidelberg, Jaspers came into contact with many of the leading intellectuals of his day: Max Weber, Friedrich Gundolf, Georg Lukács, and Ernst Bloch amongst others. It was here too that he met Ernst Mayer who was later to introduce Jaspers to his sister Gertrud whom Jaspers married in 1910.

On completing his medical studies, Jaspers worked as an unpaid assistant in Heidelberg’s Clinic of Psychiatry, which was at the time under the leadership of Franz Nissl. Hans Gruhle was a colleague. Jaspers defended his doctoral thesis ‘Homesickness and Crime’ in December 1908. In 1913 General Psychopathology was published. It marked both the end of Jaspers’ career in psychiatry and the beginning of his career in philosophy. It was accepted as his Habilitation thesis for psychology in Heidelberg’s philosophy faculty.  Jaspers remained in Heidelberg until after the 2nd World War in 1948 when he moved to Basel University.

Although Jaspers is regarded as an existential philosopher influenced by Nietzsche and Kierkegaard, it is for General Psychopathology that psychiatrists know him. He was a contemporary of Martin Heidegger, and influenced Hannah Arendt and Paul Ricoeur.  As an existential philosopher, he dealt with the problem of individual freedom and responsibility.

General Psychopathology

In the preface to the first edition, Jaspers wrote

‘…in psychopathology it is dangerous merely to learn the matter, our task is not to ‘learn psychopathology’ but to learn to observe, ask questions, analyse and think in psychopathological terms. I would like to help the student to acquire a well-ordered body of knowledge, which will offer a point of departure for new observations and enable him to set freshly acquired knowledge in its proper place’.

It is clear from this quotation that Jaspers aimed for an approach, a methodology to psychopathology and that for him, the central problems, ‘difficult and ultimate problems’ as he termed them were his main concern. But, what were these problems? They were how to take an individual case and abstract from it broad concepts, principles that assist in the recognition, description and analysis of real and distinguishable psychological phenomena such that these become communicable concepts that can be formulated into laws.  And furthermore, that these phenomena can be examined for demonstrable relationships. The special problems for psychopathology concerned the fact that Man is not merely an animal, that he is conscious, that is that he is self-aware, and that there is a distinction to be drawn between an inner subjective world and an outer objective world.

Jaspers’ primary method was the

‘selection, delimitation, differentiation and description of particular phenomena of experience which then, through the use of allotted term, become defined and capable of identification time and again’.

The intention was not to be concerned with the sources of such phenomena nor with the way that one phenomenon emerges from another. Indeed, there was no concern with theories about underlying mechanism or causes. In this, Jaspers aimed merely for the description of actual experience. And insofar as subjective experience was concerned, empathy was a necessary tool.

One of the controversial aspects of Jaspers’ account of phenomenology is his description of the limits of understanding, what he termed the ‘un-understandable’.  In Jaspers’ work, this is a term with manifold meanings. At its most basic, it refers to the problem of empathizing with an abnormal experience that has no normal frame of reference. Such an experience is so radically different that the objectifying attitude of empathic understanding fails. For example, the belief that one is merely a passive actor under the influence of foreign or alien powers or that one is simply automaton controlled by external agencies such as Martians, in Jaspers’ terms would be radically un-understandable. This is sometimes misunderstood as implying that somehow the individual subject of experience is no longer within the ken of our concern.  That the concept of un-understandability removes subjects of radically unusual experiences outside the fellowship of others. Some have argued too that this concept is merely a measure of the distance that one is willing to travel or the effort that a psychiatrist is willing to make in order to try to understand another person.

General Psychopathology remains relevant because it systematized the basic and elementary units of abnormal psychological experience. Such important notions as form, content, delusions and hallucinations were defined and clarified. But most of all, Jaspers introduced a method, an approach that has remained fruitful and cogent even into the 21st century.

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