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妄想症与精神分裂的现象学精神病理学解释
徐献军
Phenomenological Psychopathology on Delusion and Schizophrenia
Xu Xianjun

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摘要 

现象学精神病理学是以现象学为理论框架的精神病理学方向,它特别重视对精神病人主观经验的探索。在它看来,精神疾病不仅是病人有意识经验的紊乱,更是前意识经验结构的紊乱。通过对疾病前意识维度的探索,精神医师可以把握第三人称的大脑神经生理研究所不能把握的东西。现象学不仅能够帮助精神科医生理解病人独特的主观经验及世界,而且能为精神病理学提供丰富的概念描述框架,如共感、自我感、意识等。尽管目前现象学与神经生理研究仍存在相当大的距离,然而现有工作表明,现象学与神经科学及其他自然科学进路之间存在着相当大的协同促进的潜力。对于人类精神疾病谜团的破解,人文科学与自然科学缺一不可。

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徐献军
Abstract

Karl Jaspers, Eugene Minkowski and Ludwig Binswanger are the founders of phenomenological psychopathology. It was Jaspers who first brought phenomenology into psychopathology. Minkowski was the first to introduce phenomenology into psychiatry in France. Binswanger devoted himself to replacing the psychoanalysis of Freud with the existentialism of Heidegger. In the 1970s, mainstream psychiatry gradually turned a cold shoulder to phenomenological psychopathology due to the overspreading of natural-science methodology, which turned psychopathology from an interdisciplinary science of liberal arts and natural science into a pure natural science dominated by neuroscience. However, phenomenological psychopathology has undergone a significant revival during the last twenty years because psychiatrists have paid more and more attention to patients' subjective experience and have published a large number of papers and books in this field. Jaspers proposed that the key criterion for diagnosing delusion is the contrariety or the break of patients' personality as is reflected in their language and originated from some unknown neurophysiologic process. That is the reason why in his diagnosis of delusion Jaspers put emphasis on both the context of personality development and the research on neurophysiology. The neurophysiologic foundation of delusion was speculated by Jaspers, but contemporary phenomenological psychopathology has postulated it as hyperdopaminergia. It is the abnormal dopamine firing that leads to the aberrant assignment of salience to the elements of one's experience at the phenomenological level. As far as schizophrenia is concerned, mainstream psychopathology focuses mainly on its physiological and cognitive mechanism, while phenomenological psychopathology emphasizes the systematic study of its subjective experience. According to Minkowski, schizophrenia possesses two aspects. One is that patients tend to manifest a loss of vital contact with reality and a dulling of subjective lives.The other is the tendency of over-rationalization and/or a kind of geometrical or quasi-mathematical abstraction. But according to Wolfgang Blankenburg, the central defect of schizophrenia is the loss of natural self-evidence. So patients have to fully concentrate and consciously control the processes which are automatically completed by normal people. Josef Parnas and Luis Sass expanded Minkowski's idea and proposed that schizophrenia is characterized by two kinds of abnormal consciousness and ego experience, i.e. diminished self-affection and hyperreflexivity. In summary, phenomenological psychopathology provides a rich description of the subjective experience with regard to the mental diseases and integrates phenomenological description with neural physiological explanation. Mental disability is neither an abstract concept nor a phenomenon which finds its definition only in neural physiology, but the abnormality of the pre-consciousness self-affection and the structure of subjective experiences. Phenomenological psychopathology overcomes the academism and emptiness of phenomenological philosophy and realizes Husserl's phenomenological commitment of returning to the living world. Its development and revival clearly show that philosophy not only can but also need intervene in the real life of human beings rather than stay in its ivory tower.

    
引用本文:   
徐献军. 妄想症与精神分裂的现象学精神病理学解释[J]. 浙江大学学报(人文社会科学版), 2015, 1(4): 121-129. Xu Xianjun. Phenomenological Psychopathology on Delusion and Schizophrenia. JOURNAL OF ZHEJIANG UNIVERSITY, 2015, 1(4): 121-129.
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https://www.zjujournals.com/soc/CN/     或     https://www.zjujournals.com/soc/CN/Y2015/V1/I4/121
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