‘Man is part mind, part nature, and at the same time both. The whole of our learning therefore is needed for his proper understanding.’ (Jaspers Reference Jaspers1963 reprint: pp. 45–6)
General Psychopathology (Allgemeine Psychopathologie) is an epic work.rk. Published in Reference Jaspers1913, it is ambitious, long (two volumes) and one whose legacy persists. Today, Jaspers is less misunderstood than under-read but amid the general dissatisfaction with current classification models of mental disorders, General Psychopathology has never been more relevant.
Jaspers was born in 1883 to an upper middle-class German family. Diagnosed with bronchiectasis in his youth, he believed his life would be short (although he lived until he was 86). He studied medicine, and then psychiatry, but had to leave clinical work owing to ill health. He went on to become a highly respected philosopher. Hannah Arendt was his PhD student and Heidegger his contemporary. He married Gertrude Mayer, a Jewish woman, and when the Nazis came to power, he was forced to give up his university post. In the years following the Second World War, he became a public intellectual in Germany and was particularly known for his lectures ‘On the question of German guilt’ (Kirkbright Reference Kirkbright2004). His was a life lived ethically, with a clear sense of moral agency, and this is evident in General Psychopathology.
General Psychopathology impresses from the offset with its intelligence and clarity, but what strikes one most is Jaspers’ deep respect for the totality of human experience. His ‘dear reader’ style belies the scale of his ambitions for his audience, which includes the ordinary superintendent of a large asylum, the methodical schizophrenia researcher, and perhaps the rather disillusioned community mental health team consultant. His style is not to intellectually seduce but to expose confusion, bias and errors of methodology. The book blends philosophy, rigorous analysis and detailed clinical examples which – despite the 100-year gap – will be recognisable to the reader from their own clinical experience. Here, Jaspers lays out his foundation for descriptive psychopathology as we know it. There is not much in modern psychiatry – clinically or conceptually – that is not in General Psychopathology.
On explaining versus understanding (erkläen versus verstehen)
Jaspers is best known for his application of philosophy to methodology in psychiatry. He made the case that two different methods (or bodies of knowledge) were required for psychiatry to address the particular predicament of what it was to be human – a being in the world – and how knowledge of oneself and the world around (culture) influenced the way in which a person expressed and understood themselves. These two methods were explaining (erklären) and understanding (verstehen).
‘Explaining’ is perhaps best thought of as a scientific approach, dealing with cause and effect, bringing about replicable objective data. This method – although very important – was, in Jaspers’ opinion, not sufficient to understand psychopathology, which by its nature dealt in subjective experience. A second method, ‘understanding’, was required and this relates to what Jaspers termed ‘the psychology of meaningful connections’ (Jaspers Reference Jaspers1963 reprint: p. ix). It refers to how one event is understood best by its relation to another event, as an organic developing out of. Essentially, a more hermeneutic approach.
As such, science is causal and seen externally, whereas meaningful psychological connection is how psychic life is understood from ‘the inside’, for example why someone becomes angry or jealous. Jaspers described these two methods as representing ‘totally different, ultimate sources of knowledge’ (Jaspers Reference Jaspers1963 reprint: p. 28). One might think of them as the opposing methods of the sciences and the humanities, which was the intersection at which Jaspers situated psychiatry, giving it a special status among medical disciplines. The essence of General Psychopathology is that both methods are fundamental to the task at hand, although not always required at the same time.
On prejudice
Jaspers writes that ‘theory lurks in every fact’ (Jaspers Reference Jaspers1963 reprint: p. 17). We smuggle our assumptions into everything, usually unconsciously. He writes of a number of prejudices interfering with our ability to think clearly and in particular the problem of somatic prejudice. This refers to the ever-present idea that a psychic event is entirely reducible to a brain event. Jaspers believed this had a detrimental effect on conceptual thinking in psychiatry, and in particular on psychopathology, and termed this ‘brain mythologies’ (Jaspers Reference Jaspers1963 reprint: p. 18). This is a critique that has just as much relevance now as it did in 1913.
On empathy as a critical tool
Jaspers was influenced by a number of philosophers and thinkers including Wilhelm Dilthey, Max Weber and Edmund Husserl (Stanghellini & Fuchs, Reference Stanghellini and Fuchs2013; Hafner Reference Hafner2015). From Husserl he adapted the phenomenological method of epoché (or bracketing), which had as its ideal the taking of a conscious experience and examining it without influence or prejudice, i.e. putting aside any theoretical preconceptions and just attending to the material presented to you. Jaspers termed this ‘static understanding’ and applied it to psychopathology. This formed the basis for descriptive psychopathology in psychiatry, allowing for accurate description and classification of symptoms and experiences. Jaspers regarded empathy as the key tool in allowing us to think our way into another person’s subjectivity. He used this technique both in his forensic conceptual analysis and as a demonstration of one of the most profound ways of being with another person in the world:
‘There is a natural way of empathic listening to others in which we simultaneously keep touch with ourselves. Every psychopathologist depends on his power to see and experience and on the range, receptivity and complexity of such power. There is an immense difference between those who blunder about among the sick and those who take an unhesitating course in the light of their sensitive perceptions’ (Jaspers Reference Jaspers1963 reprint: pp. 21–2).
On the whole versus its part
Jaspers terms this problem ‘grasping complex unities’ (Jaspers Reference Jaspers1963 reprint: p. 25):
‘In grasping particulars we make a mistake if we forget the comprehensive whole in which and through which they exist. This never becomes the direct area of our study but only does so via the particulars. It is never examined in itself but only in the form of some schema of its essence. In itself it remains an idea’ (Jaspers Reference Jaspers1963 reprint: pp. 28–9).
This idea runs through the whole of General Psychopathology. Jaspers demonstrates it with examples of how individual disturbances relate directly to one’s ‘constitution’, which he terms that ‘complex unity of the living individual’ (Jaspers Reference Jaspers1963 reprint: p. 29). In brief, it is a consideration of how symptoms relate to personality – not at a superficial level but at depth. This idea of the essential way in which the part (i.e. symptoms) relates to the whole (i.e. psyche) is often forgotten, as demonstrated in the way modern research, classification systems and healthcare services (with all their subspecialties) are organised.
On delusions
Jaspers is perhaps best known for his work on delusions. He drew a distinction between primary and secondary delusions. His conceptual criteria for delusions are well-known: that the belief is (a) held with extraordinary conviction, (b) incorrigible and (c) bizarre in content. He underlined the distinction between form and content. Jaspers regarded primary delusions as having something like a two-stage process, the first being the delusional atmosphere (the uncanny sense that something strange was happening), which was resolved by the second stage, the primary delusion. Jaspers described patients as feeling ‘as if they have lost their grip on things, they feel gross uncertainty which gives them instinctively to look for some fixed point to which they can cling’ (Jaspers Reference Jaspers1963 reprint: p. 98). He goes on to describe ‘convictions of persecution, or having committed a crime, of being accused or, by contrast, of some golden age, transfiguration, sanctification, etc.’ as a fixation which offers a world of new meanings and ‘the awareness of meaning undergoes a radical transformation’ (Jaspers Reference Jaspers1963 reprint: p. 99). Jaspers regarded secondary delusions as understandable when related to the psychological context, affect, etc. within which they had arisen. Primary delusions had the quality of ‘un-understandability’, which refers to the idea of something ‘phenomenologically final’, i.e. something that could not be comprehended through the method of empathic understanding.
Jaspers saw primary delusions as enacting, or emerging from, a deep change in the personality:
‘his world has changed to the extent that a changed knowledge of reality so rules and pervades it that any correction would mean a collapse of Being itself, in so far as it is for him his actual awareness of existence. Man cannot believe something that negates his existence. Such formulations, however, are only trying to make us understand what in its essence cannot be understood – i.e. the specific schizophrenic incorrigibility’ (Jaspers Reference Jaspers1963 reprint: p. 105).
Jaspers voiced doubts that ordinary language could stretch to express this subjective change, writing that delusional content ‘is certainly not meant literally and is quite differently experienced from similar content in the case of a person whom we can fully understand’ (Jaspers Reference Jaspers1963 reprint: p. 99).
On ‘marginal situations’
‘Marginal situations’ is a term that Jaspers gave to a particular existential aspect of what it was to be human and how this interacts at the level of the unique individual. It links to his later works on existential philosophy:.
‘To live involves struggle, impact, creation. It means breaking against the world, adapting to it, learning and getting to know it […] In real life, the situation releases activity, and gives birth to performance and experience […] The psychology of meaningful phenomena investigates individual attitudes to typical situations. It objectifies the way in which coincidence, opportunity and destiny come to us through the situation itself and how we grasp or lose them. Situations have urgency, their sequence is changeable and unfixed, and mankind can contrive them. We use the term marginal situations for the ultimate situations like death, guilt, and inevitable struggle, which determine the whole of life unavoidably, though they go hidden and unheeded in our every day existence. The human experience, appropriation and conquest of these marginal situations remain the final sources of what we really are and of what we can become’ (Jaspers Reference Jaspers1963 reprint: pp. 325–6).
Conclusion
General Psychopathology takes seriously what it is to be a person in the world and the task of systematic conceptualisation. It is an extraordinary book infused with purpose. It aims not only to advance the science of psychopathology and put it on a surer footing (although that is its assured legacy), but also to bring in the humility that is inherent in the clinical encounter – two subjective minds meeting, grasping an understanding empathically, feeling their way into each other’s worlds with the idea that the person can be a little bit less lonely for it. For to be understood (and explained) is everything.
Funding
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Declaration of interest
None.
eLetters
No eLetters have been published for this article.