Delusion

from Wikipedia, the free encyclopedia

Wahn is the name for a mental state that is characterized by strong self-centeredness and wrong judgments about reality and thus leads to uncorrectable beliefs. If such a private reality completely determines the life of the person concerned, the delusion can be viewed as an illness. In medicine, the delusion as a symptom is distinguished from the occurrence of a paranoid syndrome , which can occur in various diseases and is also referred to as "delusion". In addition, we know a specific disease that is also named with the term. Delusional syndromes are not uncommon, they occur most frequently in the context of schizophrenia and are treated according to the guidelines for the treatment of this disorder. The delusional content is diverse, culturally shaped and historically contingent. In art and literature, delusion is not infrequently mentioned and is sometimes the central theme of a work of art.

definition

In current textbooks, a strict definition of madness is often avoided; instead, simple and pragmatic rules are often set up (as in the introduction). The rationale for this is the peculiar observation that the delusion, while difficult to define, is easy to recognize. This is sometimes compared to the fact that a competent speaker does not know grammatical rules exactly, but applies them correctly anyway. In fact, the retest reliability of experienced examiners is quite high in the case of a diagnosis of madness. The problems of certain definitions, such as the “impossibility of the content”, the so-called “third Jaspersian criterion”, are dealt with in the corresponding subsections.

Story of madness

The delusion is not only present in all cultures, but also historically widespread. The phenomenon can therefore be proven for all epochs for which sufficient written evidence is available. For the discussion of the scientific term, however, a restriction to the period since the Renaissance is sufficient.

Early modern age

The doctor Johann Weyer is considered one of the earliest critics of the witch trials. Weyer did not deny the existence of the witchcraft, but assumed that the persons concerned were victims of a deception, a deception. He explained that the witchcraft, the so-called damage spell, were ineffective. This argument was aimed at removing the basis of criminal proceedings by denying the facts. As a result of the publication of his educational pamphlet De Praestigiis Daemonum , torture and the death penalty were banned for the first time in certain regions, and the number of trials fell. In medical history literature, Weyer's argument " that even the most horrible incantation could harm no one and (those affected), as if plagued by melancholy, only imagined that they have caused all sorts of evils " is an early description of what constitutes delusion - a powerful illusion.

Early modern attempts to explain the causes of madness are known from art and literature. It was widely believed that the delusion resulted from the introduction of a foreign body into the brain. Accordingly, attempts were made to remove this so-called “fool's stone” surgically. Already known in antiquity, but reinforced by the spread of blood-mystical notions, the transmission of heart's blood through the gaze was discussed as a cause of excessive infatuation. This should then explain the morbid attraction between the lovers.

Enlightenment and 19th century

With the discovery of galvanism , an intensive transformation of delusions and theories of delusions begins. In literature - as in Kleist's Das Käthchen von Heilbronn - love is transmitted “electrically”, patients like Daniel Paul Schreber report in detail about harmful radiation and in psychiatry, John Brown's “stimulus-excitation theory” is used in conjunction with Johann Christian Reil's “teaching from the soul organ "electrical disease theories popular.

The development of psychiatry in the first half of the 19th century is characterized by increasing medicalization: Doctors seize the asylums and take over the power of definition in questions of mental disorders. In France Esquirol is the first to call for a professionalization of the discipline, in England John Connolly introduces the “non-restrain principle” and thus abolishes pre-Enlightenment penal practices (such as Christian Franz Paullini's ) and in Germany it becomes scientific of the subject defined by Wilhelm Griesinger . The widespread theory among doctors is the so-called “unit theory of psychiatric diseases” - in short, the theory of “unit psychosis”, which goes back to the work of Ernst Albert Zeller and Joseph Guislain . The manifold problems of this concept, in which the delusion is a consequence of an affect disorder , leads to a profound criticism, which was first formulated by Ludwig Snell , as a result of which the concept was increasingly abandoned.

Snell's criticism of unitary psychosis is the decisive step in the development of the delusional theory. Whereas in the past delusion was viewed either as a stage in the development of a disease process or as a curious derailment of normal affects, doctors now perceive the delusional syndrome as the core of certain disorders. Based on the work of Karl Ludwig Kahlbaum on catatonia and Ewald Hecker on hebephrenia , Emil Kraepelin then designed the concept of standardizing the three disorders paranoia, hebephrenia and catatonia to form dementia praecox . At the same time, he distinguished this comparatively common disorder from the very rare clinical picture of isolated madness.

20th century

The recent past has again been marked by a profound change in the understanding of what is delusional. While in France and the USA psychiatric pathology in the first half of the last century was strongly influenced by psychoanalysis through the work of Melanie Klein and Jacques Lacan , psychopathological research dominated in German-speaking countries in the wake of Karl Jaspers . With the introduction of effective treatment methods using neuroleptics and the increasing spread of empirically oriented diagnostic manuals, theory-based delusional teachings are increasingly becoming a marginal phenomenon in psychiatry. Today, biologically oriented psychiatrists sometimes regard psychopathology as superfluous and elaborate delusional theories as the result of wishful thinking in which curious doctors fall for bored patients. In order to approach the medical understanding of madness, one will have to fall back on concepts from the first half of the 20th century, which are often considered out of date in today's textbooks.

The delusional doctrine in the 20th century

Emil Kraepelin

Emil Kraepelin's theory of delusions is not uniform, it was subject to changes in the course of his life. These can be divided into three phases. In the first phase, represented by the 6th edition of his textbook from 1899, there is an overlap with organically acting clinical pictures, here Kreapelin emphasizes changes in consciousness in the context of the disorder. In the second phase, represented by the 8th edition of his textbook from 1915, he describes paranoia as the creeping development of a delusional system. In the third phase, in the text manifestations of insanity from 1920, he received psychodynamic considerations. It is very likely that Kraepelin followed the discussion on the topic and knew and, in some cases, received the appearances of important publications between the respective editions of his textbook. Between the 6th and 8th editions of Kraepelin's textbook are the publications of Jaspers' Study on Jealousy Mania (1910), Karl Bonhoeffer's work on exogenous psychoses (1910), Freud's monograph on the Schreber case (1911) and Gaupp's paper on the Wagner case by 1914. Between the 8th edition of the textbook and the essay on the "manifestations of insanity" lies the publication of Kretschmer's work Der sensitive relational delusion (1918).

The first phase can be characterized as follows. In the 6th edition of his textbook in 1899 the following definition is found: The delusion is a disturbance of thinking, more precisely a disturbance of judgment and conclusion. The delusion includes pathologically falsified ideas that are not amenable to correction by means of evidence. The delusional ideas have their origin not in experience or reflection, but in belief. The origin of the madness lies in the ego (not in object consciousness, but in ego consciousness). The emergence of delusional ideas is accompanied by feelings; in fact, affects are a delusional force. The hallmark of delusional ideas is their undoubted certainty. The delusion is accompanied by a change in consciousness and this marks the "general pathological change in the entire brain performance".

In the second phase, around 1915, Kraepelin completely reformulated his theory of delusions. If we try to define the concept of paranoia ... it would be about the creeping development of a permanent, unshakable delusional system resulting from internal causes, which goes hand in hand with the perfect preservation of clarity and order in thinking, willing and acting. Here, that profound transformation of the entire outlook on life, that “shifting” of the point of view towards the environment, which one wanted to label with the name of “madness”. ”Kraepelin then explained the three building factors of madness. These are "visionary ecstatic experiences", "falsified memories" and a "cumulatively developing relationship mania". These three building factors contribute to the formation of delusions and this ranges between delusions of impairment and delusions of grandeur. It then differentiates according to the frequency of the following delusions: delusions of persecution, hypochondriac delusions, delusions of jealousy and delusions of grandeur with its sub-forms of inventor delusions, high descent, prophetic delusions and redemption delusions.

In the third phase around 1920, Kraepelin made indirect reference to psychodynamic aspects of the development of the disease. One could “at least hint at psychological causes” and “the basis of the paranoid way of thinking is… to be found in the personal coloring of the outlook on life.” According to Tölle , these pathogenetic expressions of Kraepelin were influenced by the work of Gaupp. For Kraepelin, affect is the most important pathogenetic factor. This becomes clear in the "elevated self-esteem in megalomania" and the "strong vulnerability of paranoid people". This means that the pathology of self-esteem (narcissism) plays an important role in the pathogenesis of paranoia. The development of paranoia can then be interpreted from the point of view of narcissism, according to Johannes Lange , a student of Kraepelin, in the first posthumously published edition of Kraepelin's textbook in 1927 .

If one summarizes Kraepelin's views, one finds in the first phase the determination of the paranoid syndrome in the context of schizophrenia (ICD-10, F20) according to today's terminology and in the second phase the conceptual and clinical definition of the very rare isolated madness, persistent delusional disorder (ICD-10, F22) in our terminology today. The third phase is characterized by an approach to psychoanalytically oriented delusional concepts.

The Heidelberg School: Karl Jaspers - Hans Gruhle - Kurt Schneider

According to Karl Jaspers, delusion is a "subjective phenomenon of the sick soul life". Kraepelin said in a general sense that the delusion is a disruption of the “self-consciousness”, while Jaspers is of the opinion that the delusion is a disruption of the “object consciousness”. In object consciousness we have perceptions, ideas and judgments. Delusions are now falsified judgments if they fulfill the so-called Jaspersian triad :

  • the patients showed an extraordinary conviction and a subjective certainty that
  • the judgments cannot be influenced
  • and they would have an impossible content.

Jaspers then differentiates the "delusional ideas" from the "real delusional ideas". The former can be derived from affects and experiences, so they are understandable. The latter, on the other hand, are not derivable and incomprehensible, they correspond to Griesinger's concept of the “primordial delirium” and are something that is incomprehensible and incomprehensible. This aspect of incomprehensibility is related to Jaspers' theorem , the draft of a method dualism that separates scientific explanation and causal derivation from psychological understanding and empathy. The real delusional ideas or primary delusional experiences are then broken down as follows: In the case of a "delusion", the patients would have an unchanged sensual perception, but they would give this perception a special immediate meaning (delusion of meaning and delusion in relationships), and a "delusion" would be sudden Ideas and the "delusional consciousnesses" are pure abnormal consciousnesses without sensory perception.

Hans Gruhle tried to clarify the "primary delusional experiences" (Jaspers calls them "real delusional ideas") which, according to Jaspers' theorem, are characterized by incomprehensibility. Gruhle now explains that the ego relationship that emerges from a perception is the "primary , undetectable , pathological element ". He is referring to a contribution by Hagen, who explains that the madman shifts the meaning (of a state of affairs) into perception and that the sensory perception receives a special relationship to the ego, for example in the sense of a wave that suggests “Now is your business negotiates! ", Latin" Tua res agitur ".

With Kurt Schneider there are two figures of madness, the "delusion" and the "delusion". The "delusional perception" has no reason, it is characterized by a self-relationship and an abnormal meaning. It fulfills the “Jaspersian theorem” and is incomprehensible. As an example, he cites a patient's report: “The dog lay in wait for me, looked at me seriously and raised a paw. That gave me the certainty that I was dealing with a clear revelation. ”According to Schneider, the“ delusions ”have a special status. In our current terminology, they belong to Schneider's first-class symptoms and the following applies to them: “Wherever there are delusions, there is always a schizophrenic psychosis.” In contrast, the so-called “delusion” is less important for the diagnosis of schizophrenia. Schneider cites special ideas as an example, such as a religious vocation. To distinguish between delusional perception and delusion, Schneider explains that delusional perception is twofold and delusional is one-part.

If one summarizes the contributions of the Heidelberg School to the delusional doctrine, the following scheme results:

  • Jaspers 'triad and Jaspers' theorem
  • the concept of special "self-centeredness" at Gruhle
  • and the concept of "delusional perception as a first-rate symptom" at Schneider

It is important here that Gruhle and Schneider expand Jaspers' concepts. The often criticized “incomprehensibility theorem” based on method dualism is supplemented by Gruhle with the concept of “self-centeredness” and the problematic third Jaspers delusional criterion of impossible content is extended by Schneider with “delusional perception” as a content-independent criterion, because according to Schneider it differs from other “forms of madness” through its structure, a two-part process.

Delusion as an independent clinical picture

In the ICD-10 , an isolated delusional disorder will be described with F22.0 ( English delusional disorder ). This is a possibly rare, but rather severely underdiagnosed mental disorder with the leading symptom of isolated madness. In contrast to the case of schizophrenia, people who are purely delusional tend to have non-bizarre delusions, no hallucinations, fewer disorders of mood formation and no flattening of affect .

The delusions in the context of an isolated delusional disorder according to ICD-10 F22.0 are similar to excessive ideas that always have a factual relationship to reality and appear plausible at first glance. However, the thought structures in the context of the delusional disorder are even more emotionally charged and I-syntonic than over-valued ideas. Aside from their delusional issues, patients with delusional disorder usually function well in everyday life as long as no other symptoms (e.g., depressive or obsessive-compulsive structures) are added. However, the delusional thoughts can lead to conflicts in partnership, circle of friends and social life. A diagnosis of the delusional disorder is rare because the delusional thoughts do not appear factually bizarre and can therefore only be recognized as inappropriate and pathological from the context.

Medical treatment

Treatment for symptoms of delusion depends on the underlying disease causing them. Treatment is not always easy due to the generally lack of insight into the disease (resistance to therapy ). Occasionally, a patient can still be motivated to seek treatment by relatives or the doctor despite lack of insight.

If there is a risk to oneself or to others (this is by far not always the case) and there is no consent to treatment, this can be forcibly done. Psychiatric treatment varies depending on the underlying disease diagnosed (e.g., schizophrenia , depression , mania ). It is therefore of great importance to clarify the diagnosis precisely with differential diagnosis .

In principle, neuroleptics come into question in psychiatry for delusions of various types due to their antipsychotic effect. In diseases such as mania or depression, this is usually done in addition to antimanic or antidepressant medication. With the help of neuroleptics, a rapid improvement of the delusional symptoms can often be achieved. Certain delusions, such as B. delusional as part of a persistent delusional disorder, but can also be largely incurable.

literature

Textbooks

  • Borwin Bandelow, Oliver Gruber, Peter Falkai (Eds.): Short textbook psychiatry. Steinkopff Verlag, Göttingen 2008. ISBN 978-3-642-29894-3
  • Matthias Berger (Ed.): Mental illnesses. Urban & Fischer Verlag, Munich 2009. ISBN 978-3-437-22481-2
  • Gerd Huber: Psychiatry. Textbook for study and further education. Schattauer Verlag, Stuttgart 1999 (1st edition 1974). ISBN 3-7945-1857-8
  • Karl Jaspers General Psychopathology. Springer Verlag, Berlin 1973 ISBN 3-540-03340-8
  • Christian Scharfetter: General Psychopathology. An introduction. Georg Thieme Verlag, Stuttgart 2010 (1st edition 1976). ISBN 3-13-531504-5
  • Kurt Schneider: Clinical Psychopathology. Georg Thieme Verlag, 2007 (1st edition 1946). ISBN 978-3-13-398215-3

History of Psychiatry

  • Cornelia Brink: Limits of the institution. Psychiatry and Society in Germany 1860–1980. Wallstein Verlag, Göttingen 2010. ISBN 978-3-8353-0623-3
  • Hans-Walter Schmuhl, Volker Roelcke (ed.): Heroic therapies. German Psychiatry in International Comparison 1918–1945. Wallstein Verlag, Göttingen 2013. ISBN 978-3-8353-1299-9
  • Heinz Schott, Rainer Tölle: History of Psychiatry. Disease teachings, wrong turns, forms of treatment. CH Beck Verlag, Munich 2006. ISBN 978-3-406-53555-0

Monographs and collections of articles

  • Klaus Conrad: The beginning schizophrenia. Attempt a gestalt analysis of madness. Psychiatrie-Verlag, Bonn 2013 (1st edition 1959). ISBN 978-3-88414-525-8
  • Petra Garlipp and Horst Halthof (eds.): Rare delusional disorders - psychopathology diagnostics therapy. Steinkopff Verlag, 2010 ISBN 978-3-7985-1876-6
  • Heinz Häfner : Insights into mad worlds. A documentation. In: Hans Magnus Enzensberger (Ed.): Kursbuch. Volume 3, 1965.
  • Heinz Häfner: The riddle of schizophrenia. A disease is deciphered. CH Beck Verlag, Munich 2005. ISBN 3-406-52458-3
  • Gerd Huber and Gisela Groß: Wahn. A descriptive-phenomenological study of schizophrenic madness. Enke Verlag, Stuttgart 1977. ISBN 3-432-89061-3
  • Markus Jäger: Concepts of Psychopathology - From Karl Jaspers to the Approaches of the 21st Century. Kohlhammer, Stuttgart 2016 ISBN 978-3-17-029780-7
  • Wolfgang P. Kaschka and Eberhard Lungershausen (eds.): Paranoid disorders. Springer-Verlag, Berlin 1992. ISBN 978-3-540-55479-0
  • Matthias Lammel u. a. (Ed.): Delusion and schizophrenia. Psychopathology and Forensic Relevance. Medical Publishing Company, Berlin 2011. ISBN 978-3-941468-20-7
  • Manfred Spitzer: What is madness? Studies on the delusional problem. Springer Verlag, Berlin 1989. ISBN 978-3-540-51072-7
  • Thomas Stompe (ed.): Delusional analyzes. Medical Publishing Company, Berlin 2012. ISBN 978-3-941468-41-2
  • Rainer Tölle: Crazy. Mental illnesses, historical events, literary topics. Schattauer Verlag, Stuttgart 2008. ISBN 978-3-7945-2389-4

Manuals

  • Horst Dilling, H. Freyberger (translator and ed.): Pocket guide to the ICD-10. Classification of mental disorders. Hans Huber Verlag, Bern 2006. ISBN 3-456-84255-4
  • Wolfgang Trabert, Rolf-Dieter Stieglitz (ed.): The AMPD system. Manual for the documentation of psychiatric findings. Hofgrefe Verlag, Göttingen 2007. ISBN 978-3-8017-1925-8

Web links

Wikiquote: Madness  - Quotes
Wiktionary: Wahn  - explanations of meanings, word origins, synonyms, translations

supporting documents

  1. ↑ GE Berrios, D. Beer: The notion of unitary psychosis: a conceptual history. In: History of Psychiatry, Vol. 5, No. 17, pp. 13-36. [1]
  2. ^ Abdullah Kraam: On the Origin of the Clinical Standpoint in Psychiatry: By Dr Ewald Hecker in Görlitz. History of Psychiatry, Vol. 15, No. 3, pp. 345-360. [2]
  3. ^ Abdullah Kraam, Paula Phillips: Hebephrenia: a conceptual history. In: History of Psychiatry, Vol. 23, No. 4, pp. 387-403. [3]
  4. ↑ Wolfram Schmitt: The madness in the view of Karl Jaspers in the problem-historical context. In: Lammel (Ed.) Wahn und Schizophrenie. Pp. 17-33. Quotes from: Emil Kraepelin: Psychiatrie. Textbook for students and doctors. 6th edition 1899. pp. 159-168.
  5. ↑ Schott-Tölle: History of Psychiatry P. 388, is quoted: Emil Kraepelin: Psychiatrie. 8th edition 1915, p. 1713.
  6. ↑ Michael Schmidt-Degenhardt: The Paranoia Question - Problem-historical and psychopathological considerations. In: Lammel (Ed.) Wahn und Schizophrenie. Pp. 33-46. It is quoted: Emil Kraepelin. Psychiatry. 8th edition 1915, pp. 1715-1721.
  7. ^ Emil Kraepelin: manifestations of insanity. In: Z. Ges. Neurol. Psychiatry. No. 62 pp. 1-29. 1920.
  8. ↑ Michael Schmidt-Degenhardt: The Paranoia Question - Problem-historical and psychopathological considerations. In: Lammel (Ed.): Wahn und Schizophrenie , pp. 33–46. It is quoted: Emil Kraepelin. Psychiatry. 8th edition 1915, pp. 1715-1721.
  9. ↑ Karl Jaspers: Jealous Man. A contribution to the question: “Development of a personality” or “process”? (1910), in K. Jaspers: Collected writings on psychopathology (pp. 85-141). Springer-Verlag, Berlin 1963.
  10. ↑ In an exchange of letters between Gruhle and Max Weber Weber writes: “What is specific about understanding psychology ... is that there is (in the symptom) a meaningful relationship to the psychological process, the symptom means something in terms of content: (this is) a fundamental opposition to all scientific concept formation. ”This is a criticism by Weber of Jaspers' theorem, which is then taken up by the Tübingen school. Compare: J. Frommer and S. Frommer: Max Weber's importance for the concept of understanding in psychiatry. In: Nervenarzt 1990, 61, pp. 397-401.
  11. ↑ Burkhart Brückner: Historicity and topicality of the theory of madness in general psychopathology by Karl Jaspers. Journal of Philosophy and Psychiatry 2 2009.
  12. ↑ Wolfram Schmitt: The madness in the view of Karl Jaspers in the problem-historical context. , in: Lammel (ed.); Delusion and schizophrenia. , Berlin 2011.
  13. ↑ Hans W. Gruhle: The Psychopathology. In: O. Bumke (Ed.) Handbuch der Geisteskrankheiten. Vol. 9, Spec. Part 5: The Schizophrenia. Pp. 135-210. Springer Berlin 1932. Quoted from: Lammel (Ed.): Wahn and Schizophrenie p. 22 f.
  14. ↑ On the other hand, there is an understandable fear: "Someone lives in fear of being arrested and suspects the criminal police at every noise."
  15. ↑ Kurt Schneider: Clinical Psychopathology. 15th edition 1967 pp. 50-55.
  16. ↑ David Semple: Oxford handbook of psychiatry. Oxford University Press, 2005, ISBN 0-19-852783-7 , p. 230.
  17. ↑ E. Hales, YES Yudofsky: The American Psychiatric Press Textbook of Psychiatry. In: American Psychiatric Publishing. Washington DC 2003.
  18. ↑ George Winokur: Comprehensive Psychiatry-Delusional Disorder. In: American Psychiatric Association. 1977, p. 513.
  19. ^ Diagnostic and Statistical Manual of Mental Disorders . 4th edition. In: American Psychiatric Association. Washington DC 2000.
  20. ^ G. Winokur: Delusional Disorder (Paranoia). In: Comprehensive Psychiatry. 1977; 18 (6), 511. Retrieved March 17, 2012. [4]
  21. ^ Brigitte Vetter: Psychiatry: A systematic textbook. Stuttgart 2007.
  22. ↑ Steffen Moritz; Tania Lincoln: Madness - Psychology. In: T. Kircher, S. Gauggel: Neuropsychology of Schizophrenia. Springer, Heidelberg 2008, ISBN 978-3-540-71146-9 , pp. 456-467.
  23. ↑ Bibliographical reference: The first edition of the book appeared in 1913. The fourth - completely revised and greatly expanded - edition was completed in 1942 and was first printed in 1946. The 7th edition from 1959 was the last edition that Jaspers had himself taken care of. The 9th edition from 1973 is an unchanged reprint of the 1959 version.