Comparative Psychiatry

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Comparative psychiatry (v. P.) is defined as a scientific field of work with the help of which mental illnesses are contrasted with one another under different social and cultural conditions. These comparisons should not only enable a better understanding of the examined group of people, but also a better way of influencing human behavior. - The obviousness of a one-sided socio- and ethnocentric psychiatry is relativized by the comparison with the mental disorders in other cultures. The V. P. is a branch of social psychiatry .

Forms and subgroups of comparative psychiatry

Transcultural Psychiatry and Ethno Psychiatry

Compared to general comparative psychiatry, comparative transcultural psychiatry is limited to the comparison of different cultural circumstances (largely without consideration of social differences and opposites). She examines the influence of these different circumstances on the development and symptoms of a mental illness. - The founder of transcultural psychiatry was Emil Kraepelin , who wrote a corresponding psychiatric report on the occasion of the Buitenzorg institution in Java, which he visited in 1904. - Both areas, transcultural psychiatry and ethno- psychiatry, are knowledge- enhancing even without comparing conclusions to ethnocentric psychiatry in that they determine the influence of archaic cultural moments on mental illness. In this respect, both terms are to be regarded as synonymous. Since the concept of the primitive mentality used by Lucien Lévy-Bruhl has provoked the criticism of the devaluation of foreign cultures, particular caution and empathy must be observed when comparing them , cf. a. → Methodology of ethnopsychoanalysis .

International psychiatry

International Psychiatry deals with and compares psychiatric issues of general international concern. These are mostly overarching questions of administrative psychiatry, such as organization (training, treatment methods, diagnostic guidelines, new institutional foundations) and determination of training content, usually without taking cultural differences into account. This is what distinguishes international from transcultural psychiatry.

methodology

Georges Devereux describes the method of his ethnopsychiatry as complementarity . It consists in the fact that a phenomenon such as mental health can be better understood from two opposing points of view than from just a single point of view (ethnocentric versus ethnocomplementary point of view). He himself uses the comparison with scientific knowledge. It depends on the viewer's point of view whether he is imagining waves or corpuscles with the Heisenberg-Bohr uncertainty relation. This methodology has also been referred to as convergence . In ethnology, convergence, analogous to the term convergence in biology, also denotes the occurrence of the same cultural phenomena among peoples living independently of one another.

If one resists the temptation to absolutize an ethnocentric or culturalist way of thinking, then an understanding of mental illness for a (comparative) historical perspective is awakened. This could be expressed in such a way that the absolutization of a “ chronocentric point of view ” in psychiatry is avoidable. When it comes to psychiatry, sociology in particular is dependent on a representation of the overall historical reality. Finally, the demand for an understanding of deviant behavior or its scientific relativization must go so far that one also poses the crucial and fundamental question of distinguishing between normal and abnormal. Last but not least, tolerance and understanding of strange behavior are also an educational ideal .

Only a psychiatry that faces up to this purely rational demand and thus also the challenge of serving as a pure and interdisciplinary science can lay claim to appreciation and thus to prestige in public opinion. As applied science in particular , a change in perspective from a technical-administrative approach to a scientific-sociological orientation is still pending .

Some positions in comparative psychiatry

Are mental illnesses comparable?

The question of whether mental illnesses are comparable at all appears to be a matter of course, but must be viewed as a basic definition requirement of every comparative psychiatry, as well as every general pathology , see the definition of the vP according to Peters given here in the introduction to this article.

To answer the question, there are two fundamentally different views with equally fundamental effects on psychiatric symptomatology, namely that of Emil Kraepelin and that of Carl Wernicke . However, the Wernickean view has become generally accepted today and is even used by younger representatives of classical German psychopathology such as B. Gerd Huber taken over. Kraepelin was of the opinion that a common cause always causes the same psychiatric condition in different individuals. Wernicke, on the other hand, said that the same psychopathological syndromes do not allow any reliable conclusions about their cause. It should be emphasized here as a paradox that of all people Emil Kraepelin, named as the founder of vP, took a position that was so opposite to the basic features of today's science. Kraepelin's view is the basis of phenomenological psychopathology (cf. the psychopathological methodology of Emil Kraepelin, Eugen Bleuler , Manfred Bleuler and the Heidelberg School or their main representatives such as Karl Jaspers , Hans W. Gruhle and Kurt Schneider ). Gerd Huber, as a younger representative of classical German psychiatry, speaks more of an expressive community of mental illnesses and not of causal similarities. Psychiatric symptoms are therefore in principle to be viewed as adaptable ( symptom change ). Huber not only mentions a change in symptoms and shape since the First World War, but also deals in this context with the importance of peristatic and social factors: The symptoms of psychiatric disorders are also shaped by socio-cultural conditions.

According to Erich Wulff, the vP can show that

“ The occurrence of certain forms and symptoms of mental illness is not a natural fact, but rather requires specific social conditions: forms of socialization that depend on economic necessities, cultural models and socially typical character attitudes of the educators create a disposition to illness; these in turn prefer certain social constellations for their manifestation, ... "

Consequences for schizophrenia research

Propaedeutics: concepts of schizophrenia , antipsychiatry

In the case of schizophrenia, with the help of comparative observations, the question arises whether this disease should not be viewed as a product of our western civilization. Various authors have e.g. B. found that ego disturbances in the form of disturbances of ego consciousness do not occur in other countries of the world as a disease like schizophrenia as in western countries. Erich Wulff collected corresponding observations in Vietnam with around 2000 psychiatric patients and described and interpreted these comparisons in great detail from the perspective of the ego and collective consciousness. The self-awareness in the western world results from the very specific strategies of self-realization , which lead to a differently stable individual self-awareness . Wulff did not find any confirmed cases of schizophrenia in Vietnamese people. In black Africa, the disease was also completely missed by comparative observers. Pfeiffer found the disease in Indonesia only sporadically in some European-educated members of the upper class.

Consequences for psychiatric diagnostics

If there is no generally widespread equality and constancy of mental illness and the symptoms on which a diagnosis is based also change depending on cultural and social conditions, the question arises as to the unmistakable and unchangeable units (invariances) that are responsible for the occurrence of psychological abnormalities are decisive. Erich Wulff saw such a chain, consisting of individual invariant links for the determination of psychological structures, in the prevailing modes of production, the instances of socialization (especially the family) and the socialization practices used. These, in turn, are determined by economic necessities but also by cultural models, each of which influences the scope for normality.

See also

Individual evidence

  1. ↑ a b c d Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology . Bechtermünz license edition, Augsburg 1997, ISBN 3-86047-864-8 , pages 410 (a + b), 175 (c), 409 (d)
  2. ↑ a b c d e Erich Wulff : Basic questions of transcultural psychiatry. In: Psychiatry and Class Society. Athenäum Fischer Taschenbuchverlag, Sozialwissenschaften, Frankfurt / M, 1972, ISBN 3-8072-4005-5 , pages 96 ff. (A), 100 (b), 97 (c), 103 (d), 129 f. (e)
  3. ^ Emil Kraepelin : Psychiatric from Java . 1904
  4. ↑ a b c Georges Devereux : Normal and abnormal - Essays on general ethnopsychiatry. Suhrkamp, ​​Frankfurt ¹1974, ISBN 3-518-06390-1 , pages 9 (a), 19 ff. (B), 19 (c)
  5. ↑ Klaus Dörner : Citizens and Irre , on the social history and sociology of science of psychiatry. Fischer Taschenbuch, Bücher des Wissens, Frankfurt / M 1975, ISBN 3-436-02101-6 , page 25
  6. ^ Rudolf Degkwitz et al. (Ed.): Mentally ill; Introduction to Psychiatry for Clinical Study . Urban & Schwarzenberg, Munich 1982, ISBN 3-541-09911-9 , Part II. Description and structure of mental illness; Cape. 5.1 Terms from general disease theory, page 49
  7. ↑ a b Gerd Huber : Psychiatry ; Systematic teaching text for students and doctors. FK Schattauer Verlag, Stuttgart 1974, ISBN 3-7945-0404-6 , pages 40, 165, 246, 252 (a); 341 (b)
  8. ^ Barahona-Fernandez and colleagues - in: Contributions to comparative psychiatry (Ed. Nikolaus Petrilowitsch ). Part 1, page 143 ff., Karger Basel 1967
  9. ^ Pfeiffer, W. - in: Contributions to comparative psychiatry (Ed. Nikolaus Petrilowitsch). Part 1, page 102 ff., Karger Basel 1967