Temporality and psychopathology

The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative–affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of self-coherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative–affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity.     

Sleep and psychopathology

This article examines the relationship between sleep disturbance and psychopathology. Epidemiological, cross-sectional, and longitudinal data suggest a high rate of comorbidity between sleep disturbance and psychopathology, particularly between insomnia, anxiety, and depression. Between 50% and 80% of psychiatric patients complain of sleep disturbances during the acute phase of their illness. Conversely, among treatment-seeking individuals with a primary complaint of insomnia and randomly selected community samples, approximately one third display a concurrent psychopathology, one third exhibit psychological symptoms that do not necessarily exceed the threshold for a psychiatric disorder, and another third present insomnia as a functionally autonomous disorder. There is a positive relationship between severity of sleep disturbances and concurrent psychopathology, but unequivocal evidence of a cause-and-effect relationship is still lacking. However, longitudinal data suggest that anxiety and stressful life events often precede acute sleep difficulties, whereas persistent insomnia may be a risk factor for subsequent development of depression. Implications for the prevention and treatment of coexisting sleep disturbance and psychopathology are discussed.     

Shame and psychopathology

The origins of the word "shame" recall the concept of the infraction of integrity both as scandal and as individualization. The human experience of shame stretches along a continuum from modesty to disabling interpersonal terror. Unlike other basic affects, its emergence is a fundamental moment in the process of self-awareness and self-object differentiation. Neglected by psychiatry because it was regarded as a moral concept, today it is possible to hypothesize that it has a biologic basis that one can attempt to describe in terms of corticothalamic pathways. In this respect, like other affects, it could be considered as a cognitive shortcut to activate specific and evolutionally useful behavioral patterns, such as concealment or a request for affiliation. It is fairly ubiquitous in psychopathology, but is clinically much more structured in its abnormal expressions in anxiety disorders, particularly social phobia, obsessive-compulsive disorder, eating disorders, body dysmorphic disorder, and even in bipolar mood disorder. In schizophrenia it has been described as being one stage in the construction of delusion. Its presence is connected to interpersonal relationship (altruism) though it seems absent in autism. The assessment of shame experiences in psychiatric patients could be useful for both pharmacological and psychotherapeutic strategies, and could provide a categorization of a new psychopathology based on abnormal affects.     

Fantasy proneness and psychopathology

Fantasy prone persons ("fantasizers") selected from "normal" populations report experiences associated with psychopathology in clinical populations (e.g., fantasies that reach hallucinatory proportions, difficulty discriminating reality from fantasy). In Study 1, we administered objective (MMPI) and projective (Rorschach) measures to high fantasy prone individuals (upper 4% of college population), medium fantasy prone individuals (middle range), and nonfantasizers (lowest 4%). Subjects who were fantasizers appeared to use fantasy for defensive or adaptive purposes compared with others and produced 8/9 modal code types on the MMPI. On the basis of the MMPI findings, a subset of fantasizers could be described as exhibiting a significant degree of psychopathology. In Study 2, a second sample of fantasy prone individuals could not be distinguished from comparison groups in contacts with professionals for help with psychological problems, use of psychotropic medication, or number of close friendships. Although fantasizers perceived themselves as less well adjusted than comparison subjects and reported greater difficulty in distinguishing fantasy from reality, most fantasizers rated their psychological functioning as adequate and above and did not differ from less fantasy prone subjects in ratings of positivity of self-concept. As demonstrated in Study 1, a subset of fantasizers did appear to be more pathological than other subjects were, with three fantasizers reporting a history of psychiatric hospitalizations. It is estimated that between 10 and 20% of fantasizers exhibit significant signs of maladjustment/psychopathology; however, as a rule, fantasy proneness does not appear to be antecedent to severe manifestations of psychopathology.     

Orienting-reflex behavior and clinical psychopathology

The effects of diagnosis, sex, age and medication on the orienting-reflex behavior of 263 psychiatric patients and 58 normal subjects were studied. Significant differences between the normal and patient groups and within the patient groups in different diagnostic categories were found. In the patient populations, further variations by types of medication received were found, whereas sex and age did not affect the orienting reflex. On the basis of frequency of response only normal subjects and patients could be distinguished, whereas amplitude analysis revealed a continuum in which the highest responses were given by normal subjects and the lowest by patients with chronic organic brain damage. In all subgroups the amplitudes of the responses of patients receiving antidepressant medication were higher than those of patients receiving antipsychotic medication.