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Book Review--Psychopathology of Psychoses from the Perspective of the Self.

Psychopathology of Psychoses from the Perspective of the Self written by the renowned and astounding Prof. Mircea Lazarescu, Ph. D., was published in 2016 in Bucharest, at the Romanian Academy Press. The catalyser of this paper--subtitled Evolutionist-phenomenological approach--is psychosis as the highest level of psychopathological expression and as core of medical psychiatric practice. Furthermore, it is the outcome of the constant interest, covering more than 50 years, paid by the author to the aforementioned topic.

Whereas the two diagnostic manuals (DSM-5 and ICD 10) now guide almost exclusively the clinical approach to psychotic disorders, the field of psychopharmacology focused on treating psychotic symptoms has developed significantly, and numerous psychopathological doctrines have emerged (their purpose is to outline as exactly as possible the causal rationales and the dynamics of psychoses), endogenous psychotic disorders are essentially the same as during Jaspers's lifetime. In a field of psychiatry focused on disease spectrums and on developmental psychopathological approach, the evolutionist perspective is an inciting one, mostly in relation to the socio-cultural dimension.

The book penned by Prof. Mircea Lazarescu, Ph. D., is divided into twelve chapters: chapters two to seven are included in Part I--Thematic Psychopathology of Delusional Psychoses, while chapters eight to twelve are comprised in Part II--Formal, Non-thematic Disorders in Psychoses.

The first chapter--Psychosis, history of a concept--represents a great insight into psychosis from a dynamic perspective, from its crystallization in mid 19th century (with ample references to Kraepelin and Jaspers) until our days, by relating to the diagnostic manuals DSM and ICD. Subsequently, the author appraises the evolutionist dimension of the concept, by relating psychosis to the identity of the self. Hence, the author mentions an impaired state where a person's self slides from its natural relation to daily life (...) his identity becomes restraint and it focuses on the meta-representational instance, which operated with probabilistic models. Furthermore, the author pleads for a continuum between psychopathology and normality, by taking into account the evolutionist doctrine extended to the cultural man.

Part I--Thematic Psychopathology of Delusional Psychoses--attempts to define delusional themes by relating them to the specific of the self, thus positing the idea that thematic psychotic transformation as a consequence of delusional ideation contents places the subject within a deviant narrative scenario unfolding a world parallel with daily life (...) where the limits or identity and autonomy fade. The first part of the book includes six chapters the follow the road to psychosis and the evolution of delusion from its germinal stage to depersonalization and transpersonalization.

The second chapter--titled Mania, depression and the road to psychosis--concerns the temporal decontextualization entailed by these two instances of affectivity; the author also focuses on the patient's history/signs during the normal period of his life. Here, the author discusses temporality distortion, which may be considered, per se, the condition of a different psychotic state, different from the hallucinatory and disorganized delusional state. In this context, the author refers to experienced pre sent, to the context of the present, to the so-called fictional worlds, to personal actuality related to communitarian actuality and to the open future that fails to progress.

The third chapter--titled Delusion--constitutes an ample argumentation for the multidimensionality and heterogeneity of this concept. Thus, the author begins by outlining an interesting history of delusion, pointing out the overwhelming role played by the primary delusion of Jaspers and by the sensitive delusion of Kretschmer in the evolution of delusional ideation as a concept. Subsequently, Prof. Lazarescu analyzes the somatic and connecting theme of delusion. The author provides a detailed analysis of self-representation using body scheme and image as an aspect of self-identity, thus targeting all levels of psychological dimension, from biological body identity to objective social identity. This chapter also includes an analysis of delusions congruent with mood, relationship, religious, xenopathic delusions, and even the narrative dimension of a person's identity related to delusion.

The fourth chapter--Perceptive disorders in psychoses--explores the mental reception of the context of the surrounding world; particular attention is paid to pseudo-hallucinations as a special expression of psycho-productive phenomena.

The fifth chapter--Dual psyche in psychoses. Dissociate states and obsessionality features the possession phenomena from a cultural perspective, by discussing them in a continuum with reality. It also includes the dual psyche trend in severe obsessional pathology, as well as in certain psychoses, which may emerge because of the belief in the possibility of being dominated, possessed by a superhuman, xenotpathic force.

The sixth chapter--Self-control loss and psyche intimacy. Schneider's first rank symptoms--presents a descriptive classification of schizophrenia-specific symptoms and the cultural model of first rank psychotic symptoms from normality.

The seventh chapter--Depersonalization in psychoses. Transpersonalization--concerns the levels of depersonalization and its full assertion in schizophrenic pathology.

Part II---Formal, Non-thematic Disorders in Psychoses--focuses on deficits associated to psychoses, which may lead to flattened identity and even loss of identity; at a certain point, even a pseudo-character of a fictional scenario is no longer functional.

The eighth chapter--Autism, obsessionality and formal disorders, a road to impaired disorganisation--is the first chapter of the second part and it features the conceptual and clinical-diagnostic relationship of pervasive development disorders, of obsessionality and of other disorders that affect thought and perception formally, as well as the evolution of psychotic disorders per se.

The ninth chapter--Ideo-verbal disorganization. Pathology of personal logos order analyzes disorganization and the place of discordant disorder symptoms between the positive and the negative poles.

The tenth chapter--Psychotic psychomotor manifestations. From behavioural disorganization to magic rituals and catatonia regards the behavioural psychopathology that gravitates around delusion, emerged as a consequence of its contents.

The eleventh chapter--Pole of negative psychotic symptomatology--escalates the complexity of negative schizophrenic symptoms, taking into account the notion of loss of self-spontaneity.

The twelfth and last chapter--Psychosis from the perspective of psychiatric clinics and of cultural anthropology--represents a synthesis that outlines the multidimensionality of psychosis, of nosographic frameworks, by continuing to relate to the evolutionist dimensions and to the socio-cultural component.

The book also contains two appendices. The first comprises a series of illustrative diagrams concerning the interference between evolutionism, culture and phenomenology, while Appendix II is a brief presentation of the author's experience regarding the Case registry for psychoses. This book includes rich and highly diverse bibliography, at the end it features an abstract, and an outline of the main ideas debated in each chapter (in English).

All chapters comprise illustrative diagrams and figures meant to help the reader clarify the meaning of the notions featured, as well as a series of clinical cases that underline the specifics and polymorphism of delusional ideas in particular and of psychotic symptoms in general, by relating them to the socio-cultural dimension.

Psychopathology of Psychoses from the Perspective of the Self is more than a monograph that presents the state of the art in the field of endogenous psychoses. Whereas it refers permanently to research and clinical syntheses of actuality, this book also follows the multidimensionality of psychosis as a concept, from its germinal stages to the evolutionist perspective, taking into account the existence of cultural man. By repeatedly relating to the conventional resources of diagnostic in order to understand the dynamics of psychotic phenomena, Prof. Mircea Lazarescu, Ph. D., opens a holistic, complex perspective, with deep philosophical and socio-cultural motivations for endogenous psychotic pathology and for the dynamics of processes leading to psychotic breakdown.

Ilinca UNTU, Roxana CHIRITA
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Author:Untu, Ilinca; Chirita, Roxana
Publication:Bulletin of Integrative Psychiatry
Article Type:Book review
Date:Dec 1, 2016
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