How and why psychiatry still needs Karl Jaspers: a dialectical account

Como e por que a psiquiatria ainda necessita de Karl Jaspers: uma leitura dialética

Comment et pourquoi la psychiatrie a encore besoin de Karl Jaspers: une lecture dialectique

Cómo y por qué la psiquiatría sigue necesitando a Karl Jaspers: una lectura dialéctica

Abstracts

In this paper, I analyze General Psychopathology, the seminal psychopathological work of the philosopher and psychiatrist Karl Jaspers, from a dialectical perspective, showing how it can contribute to contemporary psychiatry. Dialectical interpretations of this work are still scarce and generally address the part of the work in which Jaspers makes direct reference to dialectics. Instead, I expose the implicit dialectic by which the overall form of the work is organized. I take the “psychology of meaning” as an example for this dialectical account. I suggest two consequences of this dialectical account of the “psychology of meaning” for psychopathology, which I call intrisec ambiguity and epistemic particularism. Finally, I conclude by pointing out how both notions help shed some epistemological and pragmatic light on the discipline of psychiatry, in a sustained state of crisis.

Keywords:
Karl Jaspers; General Psychopathology; dialectics; psychology of meaning

Neste trabalho, analiso a Psicopatologia Geral, o trabalho psicopatológico seminal do filósofo e psiquiatra Karl Jaspers, por uma perspectiva dialética, mostrando como esta pode contribuir para a psiquiatria contemporânea. As interpretações dialéticas deste trabalho ainda são escassas e geralmente abordam a parte do trabalho na qual Jaspers faz referência direta à dialética. Em vez disso, exponho a dialética implícita pela qual a forma geral do trabalho é organizada. Tomo a “psicologia compreensiva” como um exemplo para este relato dialético. Sugiro duas conseqüências dessa apreensão dialética da “psicologia compreensiva” para a psicopatologia, que denomino ambiguidade intrínseca e particularismo epistêmico. Finalmente, concluo apontando de que modo ambas as noções ajudam a lançar alguma luz epistemológica e pragmática sobre a disciplina da psiquiatria, em contínuo estado de crise.

Palavras-chave
Karl Jaspers; Psicopatologia Geral; dialética; psicologia compreensiva

Dans cet article, j’analyse la Psychopathologie générale, l’ouvrage psychopathologique fondamental du philosophe et psychiatre Karl Jaspers, d’un point de vue dialectique, en montrant comment il peut contribuer à la psychiatrie contemporaine. Les interprétations dialectiques de cet ouvrage sont encore rares et portent généralement sur la partie de l’ouvrage dans laquelle Jaspers fait directement référence à la dialectique. En revanche, j’expose la dialectique implicite par laquelle la forme générale de l’ouvrage est organisée. Je prends la “psychologie compréhensive” comme exemple pour ce compte-rendu dialectique. Je suggère deux conséquences de cette appréhension dialectique de la “psychologie compréhensive” pour la psychopathologie, que je qualifie d’ambiguïté intrinsèque et de particularisme épistémique. Enfin, je conclus en montrant comment ces deux notions permettent d’éclairer d’un point de vue épistémologique et pragmatique la discipline psychiatrique, qui est en état de crise continue.

Mots-clés
Karl Jaspers; Psychopathologie générale; dialectique; psychologie compréhensive

En este artículo analizo la Psicopatología General, la obra psicopatológica seminal del filósofo y psiquiatra Karl Jaspers, desde una perspectiva dialéctica, mostrando cómo puede contribuir a la psiquiatría contemporánea. Las interpretaciones dialécticas de esta obra son todavía escasas y suelen abordar la parte de la obra en la que Jaspers hace referencia directa a la dialéctica. En cambio, yo expongo la dialéctica implícita mediante la cual se organiza la forma general de la obra. Tomo la “psicología comprensiva” como ejemplo de este relato dialéctico. Sugiero dos consecuencias de esta aprehensión dialéctica de la “psicología comprensiva” para la psicopatología, que denomino ambigüedad intrínseca y particularismo epistémico. Finalmente, concluyo señalando cómo ambas nociones contribuyen a arrojar alguna luz epistemológica y pragmática sobre la disciplina de la psiquiatría, que se encuentra en contínuo estado de crisis.

Palabras clave
Karl Jaspers; Psicopatología general; dialéctica; psicología compreensiva

Karl Jaspers has a unique position in the history of psychiatry, due to the foundational nature of his work. He was responsible for proposing the very notion of psychopathology as an autonomous discipline in an inaugural paper published in 1912 (1968), a year before the first edition of his masterpiece, General Psychopathology (GP) (1913/1997), which I analyze in this article. This is one of the few founding works in psychiatry that still have the power to exert a strong influence on the field to which they pertain. I would dare to say that many of the conceptual tenets of contemporary psychopathology have their roots in this seminal work.¹ Due to its lasting intergenerational influence, making a meaningful comparison of Jaspers’s original conceptual intentions with the current uses of his ideas is no simple task. As I will try to defend in this article, the complexity of Jaspers’s GP allows some interpretations that might go beyond his stated aims.

One prime example is the meaning attributed to phenomenology in GP. Though Jaspers is often recognized as the founder of phenomenological psychopathology, he ascribed this dimension of his work a secondary role. In GP itself, he writes: “It is wrong to call this book ‘the principal text of phenomenology’. The phenomenological attitude is one point of view and one chapter has been devoted to it in some detail as the viewpoint is a new one. But the whole book is directed to showing that it is only one point of view among many and holds a subordinate position at that” (p. 48).²

Jaspers’s rejection of a dominant role for phenomenology in his work is not born of a rejection of the content presented therein. Jaspers makes it clear that his only misgiving is that his work may be identified as belonging to the phenomenological current, which he sees as one point of view among many. It is the potential for his conceptions to be oversimplified that concerns him. Instead, he wishes to show that his work can and should be understood through a complex web of simultaneous perspectives. In order to understand the vehemence with which Jaspers stands against this identification, it is necessary to understand the special relation he establishes between the individual parts of his GP - that is, the content of each of the particular sciences studied in the body of the work - and the whole that results from this (Messas, 2014). Since GP is structured bottom-up in steps of increasing scientific complexity, starting from the simplest science of the description of individual altered experiences (phenomenology and psychology of objective performance) to the most complex of all, biography, we can say that none of these empirical sciences (which I will here call “particular sciences”) studied in GP could claim independence or precedence over the others.³ It is these interrelationships among the sciences themselves and between each of them and the whole into which they are organized that this article investigates with the aim of showing that the value of GP to psychiatry today can only be appreciated if it is viewed through a specific interpretative perspective.

The account I want to put forward draws on an analytical approach that I believe has been little explored in the intellectual reception of GP, namely, the investigation of its dialectical character. Before that, it is worth recalling that GP allows for many simultaneous accounts (Blankenburg, 1984). For example, in Jaspers’s defense of the distinction between human sciences (Geistenwissenchaften) and natural sciences (Naturwissenchaften), the influence of Dilthey is explicit (Rodrigues, 2005). Observed from the point of view of the inability of science to encompass the totality of its object and human existence, and the importance it gives to form over content, GP is a Kantian work (Walker, 2013). If observed in its quest for the description of altered experiences, GP is of Husserlian inspiration, as the very term “phenomenology” attests.⁴

However, if GP is viewed from the perspective of the interrelations between the particular sciences it addresses and their respective methodology, then it is frankly dialectical, in a Hegelian sense. Here I understand “Hegelian” to mean the dialectical relationship between parts of a whole, whose result is the absorption of one of them into the whole, without, however, dissolving their own independent characteristics.⁵ Although Jaspers himself made frequent highly favorable allusions to Hegel’s genius, properly dialectical interpretations of his GP are still scarce (Doerr-Zegers & Pelegrina-Cetrán, 2013; Doerr-Zegers, 2020) and generally address the part of the work in which there is explicit reference to dialectics (Dörr, 2014). What I will try to reveal in this article is the implicit dialectic by which the overall form of GP is organized; and I will do this by highlighting several passages from GP that seem to permit this procedure. What I intend to show is that neither Jaspers nor his tributaries engaged in a complete reflection on what consequences the dialectical form of the work might have for an understanding of the particular sciences that make up psychiatry. It is exactly some of these consequences that I want to highlight in this paper for their relevance to contemporary psychiatry. My basic thesis is that the way in which we understand the contribution of GP to posterity is decisive in attesting its value. It is only by highlighting the “how” of its value that we can envisage the “why” of its continued indispensability.

The accomplishment of this task requires some preliminary explanation. Since the explicit goal of GP is to organize the scientific methods by which partial psychopathological knowledge is produced, investigating the reciprocal connections between these sciences becomes an inescapable task (Huber, 1984; 2002). GP is marked from beginning to end by a dialectical spirit that indicates that only by revealing their interrelationship can a full understanding of each particular science be gained. Hence, it seems legitimate to claim that the very meaning of any particular form of knowledge will also depend on its dialectical relation to the whole of the work. Thus, to develop my thesis here it would be necessary to examine each of the particular sciences studied in GP in their reciprocal interrelationships and with the whole work. As such an analysis would greatly exceed the dimensions of an article, the alternative is to take one particular science as an example and examine it in these interrrelationships. In doing this, I shall emphasize how the reciprocity of each science determines its functional value in psychiatry. This is not to say that Jaspers’s profound analyses of each particular science are of secondary value; rather, I want to emphasize that what makes him so contemporary is above all the dialectical relationship he establishes between the sciences. In this respect, a reader more skeptical of Jaspers and the value of philosophical thought in psychopathology might even say that his investigations of the particular sciences have been superseded by empirical progress. While I disagree with this idea, I would acknowledge that refuting such criticism would require some debate. However, even such a skeptic could not deny that the dialectical way in which Jaspers organized the sciences embodied a perception of them that definitively revolutionized all that we now call psychopathology and psychiatry. Although the demonstration of this dialectical “how” makes this text laborious to follow, it is necessary in view of the complexity of GP itself: I do not think it is possible to extract the richness embedded in Jaspers’s complex work without recourse to some discursive complexity.

To do this, I must first introduce and justify the particular science I intend to analyze, making then explicit its dialectical form. This science is the psychology of meaning (Verstehende Psychologie): the body of science that seeks to establish understandable relations of connection between altered mental events; that is, it seeks to establish how “psychic events ‘emerge’ out of each other” (p. 302). For this reason, based on the terms in which it is also expressed in GP, I will also call it in certain passages “meaningful [psychic] connections” or simply use the term “understanding”. One whole part of GP (Part II) is dedicated to the psychology of meaning.

I choose the psychology of meaning for two reasons. The first is because of its very character as an investigation of connections; i.e., a relational science. By definition, a science of understanding must establish connections between a psychic fact and another fact that gives rise to it. This fundamentally connective character of the psychology of meaning brings forth the dialectical relations between sciences. Second, I choose it because of its importance in the history of psychiatry. As Louis Sass (2013) points out, the set of meaningful connections encompasses the vast and rich field of everything that throughout the 20th and 21st centuries has been called hermeneutics in psychopathology. Given the importance that hermeneutics has gained throughout the history of psychiatry, understanding the meaning that Jaspers ascribed to his psychology of meaning goes far beyond a historical record. I do not think it is an exaggeration to state that understanding the meaning of the Jaspersian notion of meaningful connections allows us to rationally illuminate the limits on the employment of hermeneutic perspectives in contemporary psychiatry and psychology.

It is important to note that, for the purpose of highlighting the dialectical structure to which the psychology of meaning belongs, I shall not make a detailed analysis of the content presented in the part specially dedicated to its study (part II)⁶, as such an exercise would merely highlight the independent value of the psychology of meaning, contrary to what I intend to do here. Instead, I will turn my attention to the properly relational and contextual aspects of this knowledge, which requires the presentation and analysis of several points throughout the work in which the pschology of meaning is mentioned.

My intention with this article is to help shine some epistemological and pragmatic light on the discipline ever in crisis that is psychiatry. It is a sustained crisis that has been motivated by deficits in its epistemological models and rivalries between schools of thought, undermining our ability to construct an imaginary about what training a psychiatrist should ideally receive to be able to meet the mental health needs of contemporary societies. More than any other work, GP, as I intend to demonstrate, serves as a lucid and comprehensive guide for thinking about what competences should be developed in psychiatrists to meet the needs of the 21st century.

Participation of the psychology of meaning in the dialectical relationships between particular sciences

Jaspers explicitly proposes an important role for dialectics within the dynamics of the notion of meaningful connection, since he views it as the basic form of the understanding process and the source of its complexity: “Dialectics is the form in which a basic aspect of meaningful connections become accesible to us, namely, that these connections are not a simple sequence of events but show a constant reciprocity” (p. 345).

However, as mentioned above, it is not this explicit perspective that I want to highlight. I am more interested in analyzing how the meaningful connections interact with the work as a whole. I will begin with a brief description of the dialectical meaning that the particular sciences receive in GP. Every dialectical relation presupposes a movement between parts. In GP, every empirical science is understood as inevitably partial, limited to what its specific methods allow us to know. Each science is therefore just a part, which requires a whole to support it. The importance Jaspers places on the whole is already evident in the introduction to GP: “General psychopathology is not called upon to collect individual discoveries, but to create a context (Ganze) for them” (p. 38). It is through the creation of this whole that the particular sciences that make up the work are organized: “Divisions into chapters are necessary for clarity but to reach truth and comprehension (Vollständigkeit der Auffassung) they must all be reunited” (p. 48).

This regulative function of the whole of the work in relation to its parts does not imply, however, that the parts are completely subordinated to it, as if the sciences were merely ways of exploring a metaphysical whole. In the Jaspersian dialectic, the particular sciences and the whole of the work are articulated organically, producing an interdependency that is the source of their intellectual and scientific vigor. As Jaspers explains, “the themes of different chapters are related to each other and do not lie mechanically side by side” (p. 48).

Therefore, we must seek the potency of the chapters’ contents in the forms of this organic interrelatsionship among them. Of these contents, the aspect I will examine here is the psychology of meaning. Since GP is structured bottom-up in steps of increasing complexity, any investigation of a particular science must be carried out from the dual perspective of a horizontal and a vertical dialectic with the other particular sciences and with the whole of the work. Using horizontal dialectics, each particular science is investigated in relation to another particular science of the same level of complexity; using vertical dialectics, particular sciences are investigated with their correlates at a higher or lower level of complexity. Sciences at the same level of complexity are those that have the same goal. In the case under analysis here, the psychology of causal connections (Erklärende Psychologie) has the same level of complexity because it and the psychology of meaning share the same scientific purpose of establishing connections between events. On the other hand, sciences at different levels are interrelated with others at a lower and higher level, as we will see below.

At the horizontal hierarchical level, the notion of meaningful connection relates to that of causal connection by means of a relation that I will call antithetical determination. Correspondingly, in a vertical dialectic, the notion of meaningful connections relates to both the immediately lower (phenomenology) and higher (personality-study) levels, as well as to more distant higher levels, by means of a relation I refer to as sublational determination. Sublation is a Hegelian concept, and so is justifiable when analyzing Jaspers’s work. Basically, it means that a concept changes its meaning according to the context into which it is absorbed, following a dynamic whereby although it changes, it is still preserved under a new synthesis, as I will explain below.

The psychology of meaning is, from beginning to end, dependent on epistemological relations with its own hierarchical level and with the lower and higher levels that delimit it. Its scientific functionality - the way in which its results operate pragmatically on psychiatric activity - is given simultaneously by what defines it as a science (its own contents) and by what is exterior and opposed to it, with which it establishes a dialectic that at the same time clarifies and obscures its meaning, determining and at the same time restricting its applicability as a science. The way a Jaspersian dialectic identifies a scientific field means a psychological science can never reach an absolute degree of epistemological independence, because its very validity depends on the articulations that compose it.

I will now turn my attention to an explanation of these aspects, firstly in the horizontal dimension of the GP.

Horizontal dialectics: antithetical determination

The sciences of meaningful connections in GP are defined primarily by their positivity. They are the field in which meaningful relations between facts and their motives are examined. However, they are not restricted to this. There is an inescapable antithetical determination in the field of Jaspers’s meaningful connections, as the author reveals when he states that “as our knowledge of meanings grows we are forced up against the non-understandable. At any given moment the totality of meaning connections is grounded in the non-understandable” (p. 430). The progressive movement by which the examination of understandable relations takes place is defined when it runs up against its own limits (Cabestan, 2013). Understandable knowledge moves toward its limits - and in a sense its extinction - as a dynamic of its own production. The conceptual border of the sciences of causal relations is thus a constituent part of sciences of meaningful connections, and the opposite is also true, such that one and the other only exist in their interdependent validation. They determine themselves in opposition to each other. They can each exist simultaneously as scientific fields - fully fledged fields of knowledge - precisely because they are composed by their opposite as well.

As I will explore later, this antithetical determination is also ambiguous, for the same thing that delimits the scientific fields (what is understandable is not explicable and vice versa) also blurs their boundaries, since there must be some overlap between what is understandable and what is non-understandable. As Jaspers argues, “what psychological understanding gives us is the bond that holds together all that we can understand and all that belongs to it which we cannot understand” (p. 312). Understanding and explanation are distinct parts of a unified set of scientific procedures (that search for the origins of a phenomenon), whose results can only be validated mutually. This reciprocity means the only way to validate the conclusions arising from the psychology of meaning is to seek their limits with their opposite. Thus, for example, the understandable diagnosis of depression is equivalent to the causal non-diagnosis of hypothyroidism. The diagnosis of reactive psychotic break is equivalent to the assertion of the non-existence of exogenous biological causality, such as substance use, for example. This dynamic of executing a diagnosis of connections between phenomena adds an extra layer of complexity to the psychiatric operation. The psychiatrist has to master both sciences of connection in order to apply them correctly. Since they are defined by their opposition, only by mastering both of them can they be employed correctly, because the limiting factor given by one is what determines the viability of the application of the other. A psychiatrist can only be understanding-oriented if they also have full command of the operations of causal thinking. The scientific laws of understanding can only be validly applied by a psychiatrist in a given situation if they are also able to master the rules of the causal sciences, and vice versa. This complex requirement placed on the Jaspersian psychiatrist carries consequences that I will explore further below.

Vertical dialectics: sublational determination

To explore the sublational movement of meaningful connections in GP, we need to clarify how Jaspers articulated understanding with its immediately lowerand higher-level sciences; i.e. phenomenology and personality study. As he pointed out, “this meaningful psychology is always in balance between these two realms and we can never speak of it in isolation. It is related to them both and if there is to be a complete presentation they cannot be separated” (p. 312).

It seems no exaggeration, therefore, to state that, for Jaspers, the notion of meaningful connection can only be properly understood if examined both for its specific contents and for the way in which they are transformed through the dialectical sublations to which they must be subjected. This simultaneity is not of mere ancillary value in understanding the notion of meaning, which can only be obtained by, at one and the same time, understanding what it is and what it becomes when it meets with another related scientific field. Ultimately, it is the dialectical synthesis of these two strands. I will briefly do an exercise in this synthesis and its consequences. Respecting the bottom-up methodology expounded in GP, I begin with the relation between phenomenology and meaningful connection.

a) Downward sublation of meaningful connections with phenomenology

Jaspers is quite clear when he states that “we can hardly describe anything phenomenologically without immediately coming upon meaningful connections” (p. 311). That is, there is no phenomenology without the pressure to identify the facts that produce phenomena. Similarly, an examination of meaningful connections flows naturally to the description of psychopathological facts. As Jaspers (p. 312) puts it, “this meaningful psychology is always in balance”. Therefore, both are integral parts of one thing: experienced facts and their meaningful connections must validate each other reciprocally, in such a way that the postulation of a meaningful connection can only be validated scientifically by the way it connects to a specific fact. A phenomenologically described fact is, so to speak, essentially bound to its meaningful connection and vice versa. The endeavor to describe a subjective experience makes no epistemological sense without reference to a meaningful connection and this relation is deprived of meaning unless it is completely adequate for the subjective fact to which it is linked. This statement renders questionable or even invalid any scientific universalization regarding the use of meaningful connections. Jaspers thus limits the scope of a form of intellectual freedom that was dear to the hermeneutic psychologies of this century and the last, whereby any relation of meaning could be proposed for any subjective fact and, conversely, any subjective fact could be speculatively linked to any motivational hypothesis. Jaspers is again quite clear and incisive in lamenting that “much has been explained as meaningful which in fact was nothing of the kind” (p. 408).⁷ 7 Freud is one of the key examples Jaspers took to illustrate this flaw of psychopathological reasoning.)

b) Upward sublation of meaningful connections with personality-study

“We might say that all psychology of meaningful connections is personality-study (Charakterologie), in so far as it concerns itself solely with the connection of what is meaningful in terms of the whole man” (p. 433). Somewhat ambiguously, there is, so to speak, no psychology of meaning that is comprehensible in itself, but only a psychology of relations whose scientific validity is given by its factual presence in a typical personality style. Again, the generality that the principles of meaningful connections suggest is balanced by their applicability to the specifics of a personality. Thus, for example, although a pathological mechanism of psychic dissociation is possible, as a general rule, in anyone, for its application in a clinical case to be valid, a certain psychological type, say, a hysterical personality type, must first be identified in order for its use to be legitimately grounded in reality.

Conversely, the study of a personality can only be validated by its connection to the set of meaningful relations that make up the coherent totality of a person. Thus, “personality is constituted from psychic events and manifestations in so far as these point beyond themselves to a single, fully understandable concept” (p. 429). The higher level of personality can only be understood as a special form of absorption of the lower level of meaningful connections. Correspondingly, meaningful connections, when subsumed into a higher level, encounter the limits of their use as part of a unifying personality-type. Meaningful connections and personality study are distinct sciences with their particular methods; however, dialectically, from a bottom-up perspective, they are part of a larger science, while from a top-down perspective, they are regulated and validated by whatever hierarchically bounds them. Strictly speaking, there is no personality study that is not a synthesis of meaningful connections, while no meaningful connection can be seen as valid if detached from a particular coherent personality style. Thus, through the regulating action of sublational dialectics, there is a reciprocal relationship between psychology of meaning and its associated sciences such that they are all limited by each other, almost becoming appendages of each other, so to speak, with their status as independent sciences by being regulated by a whole that always escapes them.

The consequences of both dialectics cannot be understated. Considering antithetical determination, the psychiatrist must master two sciences of a distinct nature in order to wield them adequately. Concerning sublational determination, they must be aware of the interdependent nature of the sciences and respect the limits of their autonomy. The result of this ambiguous movement serves to make the application of any particular science more precise, while preventing it from being used to abstractly grasp an entire life. The sciences of meaning in GP are flexible, and their definitions and limits can be enlarged and restricted accordingly to the context in which they are employed.

Consequences of dialectics for the dynamics of psychopathology

I will now perform a short exercise in which I suggest two intertwined consequences of these core dialectical characteristics of the notion of understanding, which may be of relevance for the contemporary mental health debate. They are intrinsic ambiguity and epistemic particularism. I shall start with the first one.

Intrinsic ambiguity

Being ambiguous, for Jaspers, is not the result of an inability to or disinterest in defining some concept. On the contrary, few authors are as insistent as Jaspers in seeking a clear definition for their concepts. His interest is such that he revisits each concept repeatedly, registering the perspective from which it emerges and always adding a new detail to it. The ambiguity in Jaspers comes from an epistemological decision that means the concept of meanigful connection only makes sense if it is determined and restricted antithetically and by sublation with lower and higher levels; i.e., it is only ever the part of a whole, never independent. This results in a profound, inescapable ambiguity, which, at the epistemological level, brings forth the very ambiguities that constitute existence. The main inspiration for contemporary psychopathology lies precisely in this need to attune epistemological proposals to the human specificities they seek to access as a body of science. If the human being is ambiguous and indeterminate, the concepts and the dynamics employed by those who deal with them must be guided by this ambiguous dialectical aspect that is never a conceptual imperfection, but rather an epistemological perfection in its image and likeness.

Intrinsic ambiguity is thus the limitation inherent to the explanatory capacity of any particular science, insofar as its apprehension of a given object is not the only one possible: a different science may also apprehend the same object, albeit from another perspective. A fact can be examined in its meaningful and causal relations, without either perspective exhausting its potential interpretations.

Intrinsic ambiguity also explains the variation in the capacity to elucidate a phenomenon according to the method used. Example: in the same person, a manic episode can be explained simultaneously as both biologically based automatism and a meaningful reaction to some significant phenomenon. Here, ambiguity stems from the simultaneous and complementary dialectical perspective of the epistemological gaze (Messas & Fulford, 2021). As a consequence, in pragmatic terms, both sciences of connection should provide complementary inputs for the same phenomenon. Let us take reactive psychosis as an example. When addressing it from the perspective of its meaningful aspects, it is possible to work with the patient to illuminate their existential conditions of vulnerability to the psychotic experience, whereas a causal perspective can enable direct action to eliminate the psychosis. Neither, however, can be said to have overall or assumed priority in any particular clinical decision-making process.

In the vertical dialectic, there is also intrinsic ambiguity, since “thinking about personality is therefore full of ambiguities as with all psychology of meaningful connection” (p. 430). Any given higher level is so intertwined with one of its lower dialectical constituents that Jaspers no longer draws any distinction between them in terms of their ambiguity. This dialectic understanding of the interrelations between sciences, blurring the boundaries between them, means any notion of psychopathological science must be ambiguous - an ambiguity that is taken to its maximum degree in Jaspers. As the knowledge yielded by employing the psychology of meaning reappears almost unaltered at the higher, personality-study level, the unwary reader of the dialectical account may even lose track of which chapter they are in. At the same time, however, the entire research effort of personality studies is marked by a search for what is unique, what unifies an existence, what distinguishes it from the more generic terms in which the investigation of meaningful connections is carried out.

The presence of ambiguity as a leitmotif of GP can be traced throughout the general upward dialectical trajectory that leads from phenomenology (lowest level) to the study of biography (highest level). While there is no space here to demonstrate this, it is important to present the core features of this process. We can see it in the two levels above the level we have just seen (the personality level). The first one of these leads to the question of diagnosis, while the second leads to biography, the highest personal level of human assessement.

Concerning diagnosis, Jaspers muses:

what do we diagnose? - is a question that has been answered by practice in the course of time through giving names to individual symptoms [phenomenology], individual connections [meaningful connections], symptom-complexes [meaningful connections], causal relations, etc., until the idea of the disease-entity came to have a significance of its own for diagnostics -a significance that can never be final. (p. 604)

And also:

In designing a comprehensive schema of psychoses (a diagnostic schema) we want to co-ordinate all the viewpoints which have been separately discussed. But however we devise this we realise that it cannot work; that we can only make temporary and arbitrary classifications; that there are a number of different possibilities which account for the fact that different workers construct entirely different schemata [...] (p. 604)

Particularly about biography, Jaspers puts forward that:

It includes everything which we have explored in the shape of individual psychic facts and individual meaningful and causal connections. [but] It is grounded in dispositions which we can never fully comprehend and it is equally determined by the chances of life, by situations in constant transformation and by opportunities and all sorts of external events. (p. 673)

For Jaspers, knowing everything that is scientifically possible is a prerequisite for making a psychopathological reconstruction of a life. Even though the sum of this knowledge cannot encompass the whole of a life, the reconstruction must signpost how the body of sciences can be organized specifically for that particular altered life. This is Jaspers’s second legacy, as I present below.

Epistemic particularism

Under the strong influence exerted by psychoanalysis and neurosciences in Western culture during the 20th century, mental health disciplines have become less mindful of the limitations inherent to knowledge of subjectivity (Jaspers, 1959). Drawing on Jaspers’s terms, I would say we have witnessed a tendency to unquestioningly overvalue explanation (Erklären) and undervalue understanding; i.e., to theorize on aspects of mental functioning that may not be the subject of theories. (This is the core of his critique of Freud’s theory, for instance.) Jaspers bequeaths us some general rules for determining the boundaries that divide the scientific constructs about human psyche that can be accessed through empathy and those that can never be accessed through empathy and will always require an auxiliary theoretical construct. As explored above, knowing how to determine how far understanding goes and where we have to move to the realm of theoretical speculation is the main antidote that Jaspers offers us for a consistent epistemological application of the psychopathological sciences.

As I have just pointed out, the validity of any interpretation rests on an individual’s particular way of being. This means that there is no universal validity for understanding, for interpretive models that might serve homogeneously for all human beings. Every individual investigation converges in a unique way of employing the various sciences obtained by different scientific methods, configuring its epistemic particularism (Hoerl, 2013). This intellectual position protects us against the taken-for-granted universalization of extraconscious mechanisms described in some mental pathologies and extended to other ones, for which they are unfit.

However, here it is not only a matter of developing deep knowledge of a particular patient, as would be the aim of biographical research, to which Jaspers (1953) was so dedicated and which is allotted higher value in the hierarchical system of knowledge set forth in GP. It is also more than that: it is about drawing on knowledge of a particular person to decide when to use one or another science, prioritize one over the others, in order to understand a specific fact or phenomenon. It is not enough to gain deep knowledge of a person with schizophrenia, their delusional experiences, their existential dilemmas, and their values. For clinical practice, this all matters, but only to the extent that it enables the clinician to pick which psychopathological methods (of which I have highlighted here meaningful connections) they should prioritize and employ at any given moment. Often, to follow Jaspers, the same phenomenon of psychomotor agitation can be understood as partially meaningful and partially causal. Likewise, in a given situation the clinician must have objective (in the Jaspersian sense) neuropsychological knowledge to decide, together with their patient, whether or not they are cognitively able to make a certain existential decision, and so forth.

The Jaspersian dialectic, organizing as it does the entirety of psychopathological sciences, requires clinicians to have comprehensive knowledge of the particular sciences at their fingertips so they can employ them in particular cases, while also being aware of the potential and epistemological limits of each one. The Jaspersian dialectical clinician is like the conductor of an orchestra: although they may have expertise in one or another instrument, they must know the peculiarities of all of them if they are to successfully perform the music.

It is this continuously dissonant methodical attitude of the clinician that Jaspers’s dialectic perspective bequeaths to contemporary times - a time so besieged both by scientific currents keen to make some method hegemonic, often resulting in sectarianism among psychiatric approaches, but also by a mystifying denial of scientificity. It is also probably because of this methodological complexity that the influence of GP is still small in current psychiatry, founded basically on simplified nosographic models, of which the most influential are the DSM and the ICD. GP is more invoked as a solution to current impasses than understood in its spirit and intention. Although one can identify some distant influence of the Jaspersian perspective in these manuals (Mundt, 2013), especially via the work of Kurt Schneider, in general, it cannot be said that an author like Jaspers, for whom the diagnosis is the last point to be considered in the comprehension of a case, has any real influence in the present era.

Conclusions

In this article, using the example of the psychology of meaning in Karl Jaspers’s GP, I attempted to follow a dialectical trajectory that mirrors the structure of the work. In doing so, I uncovered a web of dialectical relations between particular sciences that determine and delimit the meaning of each one in the dynamics of GP. This discovery begs the question as to whether it makes sense to assert the independence of the psychology of meaning in GP. I argue that it is an independent science, provided it is understood from the two perspectives that dialectically illuminate all the scientific categories in GP: the intrinsic ambiguity and epistemic particularism of all psychopathological sciences. This is, in my view, the contribution GP can make to the effort to tackle the ongoing crisis in psychiatry. To understand a person is to inquire how their specific meaningful connnections play out at that moment in life, for that personality, with the chance occurrences, fortunes, and misfortunes that marked that particular biography. It is also to examine where these connections begin and where they are limited by causal relations. It is not to lose sight of the fact that, in understanding a life, there is always an element of irreducible biological influence and free existential decision. It means - simultanesously and paradoxically - curtailing the universal ambition of exact knowledge of a human person, and sharing with that person all our scientific knowledge so that, together with them, we can not only try to reconstruct the paths of their life that were disoriented by the disorder, but above all, in an act of amplified scientific reason, build with them a trajectory of biographical reconstruction. To look with admiration and respect at existence as a mystery is a legacy left by Jaspers that is renewed every day in clinical activity when we use dialectics to develop the art and science of understanding.

This complex requirement demands the clinician to be open to multiplicity in his/her training: multiplicity of methods, of perspectives, and of practical experiences. It also means they should reject scientific sectarianism, even though every clinician will inevitably have some personal preference for a particular perspective. Following the dialectics set forth in GP means adopting a permanent attitude of humility - something for which there is still little encouragement in psychiatry training and academic discussions.

Jaspers teaches the operators of psychopathology - everyone from clinicians to policymakers - to acknowledge their unavoidable limitations. It is these very epistemological limitations that allow psychopathology to converge on the individual in their specificity. In this sense, Jaspers’s legacy is to give us all the instruments so that the individual is never lost sight of as a scientific object, even if the study of the individual can never be restricted to the sum of the material obtained by scientific methods. It is this need for reciprocity between the general and the particular in assessing human life that is Jaspers’s most valuable legacy for our time. Building on his central philosophical view, we could say that respecting what is ungraspable in a human life remains vital in our time of unmitigated scientific uncertainty

• ERRATUM
  Rev. Latinoam. Psicopat. Fund., São Paulo, 2023, volume 26, e2303129
  No artigo “How and why psychiatry still needs Karl Jaspers: a dialectical account”, de autoria de Guilherme Messas, com número de DOI http://dx.doi.org/10.1590/1415-4714.e220950, publicado no periódico Revista Latinoamericana de Psicopatologia Fundamental, 2023, volume 26, e230312
  Onde se lia:
  http://dx.doi.org/10.1590/1415-4714.e220950
  Leia-se:
  http://dx.doi.org/10.1590/1415-4714.e230312

Acknowledgments

I would like to thank both anonymous reviewers for the comments and suggestions which have enabled the improvement of the ideas of this paper.

• 1
  For more on this topic, see Stanghellini & Fuchs, 2013.
• 2
  All emphasis in citations of GP is added.
• 3
  I have limited this account of the particular sciences to those directly linked to the purposes of this article, though this means simplifying the complexity of GP. A full account of all the particular sciences organized by Jaspers would diverge too far from the aim of this study, though I can offer a general list of them: phenomenology, psychology of objective performances, somatopsychology, psychology of expression, psychology of the personal world, work psychology, psychology of meaning, personality-study, psychology of causal connections, nosology, eidology, and biography).
• 4
  Jaspers (1994) clearly indicates the limits of this Husserlian influence: “As a method I adopted and retained Husserl’s phenomenology - which he initially called ‘descriptive psychology’ - discarding only its refinement to essence perception”), though his interpretation of Husserl is not immune to criticism (Walker, 1994).
• 5
  Dialectics is a classical case in philosophy of a term conveying many and ocasionally contradictory meanings. I do not intend here to give an account of the concept in philosophy, or even in Hegel’s work. My interest here is only to highlight a perspective of interpretation of the GP which can be attributed to the - acknowledged by Jaspers - influence of Hegel in this work).
• 6
  For this analysis, I refer to Fukuda & Tamelini, 2016.
• 7
  Freud is one of the key examples Jaspers took to illustrate this flaw of psychopathological reasoning.

References

• Blankenburg, W. (1984). Unausgeschöpftesin der psychopathologie von Karl Jaspers. Nervenarzt, 55, 447-460.
• Cabestan, P. (2013). De la compréhension et de ses limites selon Karl Jaspers. In P. Cabestan, & J. C. Gens (Eds.). La Psychopathologie Générale de Karl Jaspers 1913-2013 (pp. 109-126). Le Cercle Herméneutique Éditeur.
• Doerr-Zegers, O. (2020). Karl Jaspers: el hombre y su trascendental contribución a la psiquiatria. Psicopatologia Fenomenológica Contemporânea 9(2), 01-23
• Doerr-Zegers, O., & Pelegrina-Cetrán, H. (2013). Karl Jaspers’ General Psychopathology in the framework of clinical practice. In G. Stanghellini, & T. Fuchs (Eds.), One century of Karl Jaspers’ General Psychopathology (pp. 57-75). Oxford University Press.
• Dörr, O. (2014). Hermeneutical and dialectical thinking in psychiatry and the contribution of Karl Jaspers. In T. Fuchs, T. Breyer, & C. Mundt. (Eds.), Karl Jaspers’ philosophy and psychopathology (pp. 19-32). New York Heidelberg Dordrecht London: Springer.
• Fukuda, L.M., & Tamelini, M.G. (2016). A compreensão psicológica jasperiana revisitada sob a perspectiva da psicopatologia fenomenológica. Psicopatologia Fenomenológica Contemporânea 5(2), 160-184. http://dx.doi.org/10.37067/rpfc.v5i2.995
  » http://dx.doi.org/10.37067/rpfc.v5i2.995
• Hoerl, C. (2013). Jaspers on explaining and understanding in psychiatry. In G. Stanghellini, & T. Fuchs (Eds.), One century ok Karl Jaspers’ general psychopathology (pp.107-120). Oxford University Press.
• Huber, G. (1984). Die Bedeutug von Karl Jaspers für die Psychiatrie der Gegenwart. Nervenarzt 55, 1-9.
• Huber, G. (2002). The psychopathology of K. Jaspers and K. Schneider as a fundamental method for psychiatry. The World Journal of Biological Psychiatry, 3(1), 50-57.
• Jaspers, K. (Ed.). (1953). Strindberg et Van Gogh Swedenborg-Hölderlin. Les Éditions de Minuit.
• Jaspers, K. (1959b). Der Artz im technischen Zeitalter. Universitas: Zeitschrift für Wissenschaft, Kunst und Literatur 4, 337-354.
• Jaspers, K. (1968). The phenomenological approach in psychopathology. British Journal of Psychiatry, 114(516),1313-1323.
• Jaspers, K. (1994). Origins in scientific research: An autobiographical account. In E. Ehrlich, L.E. Ehrlich, & G.B. Pepper (Eds.), Karl Jaspers basic philosophical writings (pp. 5-8). Humanities Paperback Library.
• Jaspers, K. (Ed.). (1997). General psychopathology (Translated by J. Hoenig and Marian W. Hamilton). The Johns Hopkins University Press.
• Messas, G. (2014). O sentido da fenomenologia na Psicopatologia Geral de Karl Jaspers. Psicopatologia Fenomenológica Contemporânea, 3(1), 23-47.
• Messas, G., & Fulford, B. (2021). Three dialectics of disorder: refocusing phenomenology for 21st century psychiatry. Lancet Psychiatry, 10, 855-857.
• Mundt, C. (2013). Impact of Karl Jaspers’ General Psychopathology: the range of appraisal. In G. Stanghellini, & T. Fuchs (Eds.), One century ok Karl Jaspers’ General Psychopathology (pp. 42-54). Oxford University Press.
• Rodrigues, A.C.T. (2005). Karl Jaspers e a abordagem fenomenológica em psicopatologia. Revista Latinoamericana de Psicopatologia Fundamental, 8(4), 754-768.
• Sass, L. (2013). Jaspers, phenomenology and the ‘ontological difference’. In G. Stanghellini, & T. Fuchs (Eds.), One century ok Karl Jaspers’ General Psychopathology (pp. 95-106). Oxford University Press.
• Stanghellini, G., & Fuchs, T. (Eds.). (2013). One century ok Karl Jaspers’ General Psychopathology Oxford University Press.
• Walker, C. (2013). Form and content in Jaspers’ psychopathology. In G. Stanghellini, & T. Fuchs (Eds.) One century ok Karl Jaspers’ General Psychopathology (pp. 76-94). Oxford University Press.
• Walker, C. (1994). Karl Jaspers and Edmund Husserl, II: the divergence. Philosophy, Psychiatry & Psychology, 2, 319-341.

Publication Dates

• Publication in this collection
  20 Oct 2023
• Date of issue
  2023

History

• Received
  17 Mar 2023
• Reviewed
  14 July 2023
• Accepted
  20 July 2023