Massimiliano Aragona

The COVID-19 pandemicTellenbach, Hubertus has caused global stress. However, people reacted differently, some with various forms of distress. Although vulnerable groups were more likely to suffer in this situation, heterogeneity was also reported at this level. We revised the concept of vulnerability in medicine and mental health using schizophrenic symptoms as paradigmatic examples. In our view, studying vulnerability to stressful situations, the following points are fundamental: (1) the individual emotional reaction; (2) the personal meaning attributed to the events; (3) the way the person concretely takes position in front of this (distressing and possibly uncanny) experience; and (4) the way and extent to which the person has contributed to the determination and constitution of the stressful situation. Applied to the pandemic situation, we suggest that the reported heterogeneity of reactions depended on the personal way the persons took position in front of the situation they were experiencing. The way they took position depended on the specificities of the situation to be faced but also on their personal way of managing the consequent imbalance of their existential dimensions of anthropological vulnerability.

Sometimes it happens that the same concept is discussed independently but, at the same time, in different disciplinary fields. The recent dominance of neuroscientific research has reintroduced into the experimental realm the importance of the experimental subject’s self-evaluation to be correlated to detectable changes into brain activity. For example, the experimental subjects are instructed to press a button or move a finger when they perceive or feel something, or they fill questionnaires supposed to measure their experience; all these “data” are then statistically correlated to measures of brain functioning.

This paper tests the predictions of an epistemological model that considered the DSM psychiatric classification (in the neopositivist and neo-Kraepelinian shape introduced by the DSM-III) as a scientific paradigm in crisis. As predicted, the DSM-5 did not include revolutionary proposals in its basic structure. In particular, the possibility of a dimensional revolution has not occurred and early proposals of etiopathogenic diagnoses were not implemented due to lack of specific knowledge in that field. However, conceiving the DSM-5 as a bridge between the present phenomenally based operational diagnostic criteria and the neuro-cognitively based RDoC criteria introduces an internal tension into the system. It is expected that a liberalization of the research criteria will occur, the DSM operational criteria being only one possible way to select research subjects.

In lieu of an abstract, here is a brief excerpt of the content:About and Beyond Comorbidity:Does the Crisis of the DSM Bring on a Radical Rethinking of Descriptive Psychopathology?Massimiliano Aragona (bio)Keywordscomorbidity, nosography, phenomenology, philosophy of scienceThe problem of psychiatric comorbidity is part of a series of difficulties of the current diagnostic system which at once were considered as a consequence of the way the system itself is organized (Aragona 2006). It was then believed that a Kuhnian reformulation of the contemporary debate on the problems of the psychiatric diagnosis was very useful because it allowed clarification in a comprehensive picture of the many rivulets of conceptual research in that field.In their comments Zachar (2009) and Banzato (2009) seem to agree with my analysis of psychiatric comorbidity (Aragona 2009a) when it stresses that abnormally high frequencies of co-occurrence are to be explained, in important respects, as a consequence of the way mental disorders are operationalized in the Diagnostic and Statistical Manual of Mental Disorders (DSM; also showing the importance of conceptual clarification to deal with this sort of only apparently pure factual problems). On the contrary, they are both unconvinced of the appropriateness and/or fruitfulness of the use of the Kuhnian technical terms and theory in this context.It could be said that the major aim of the paper was to let clinicians understand the effect of conceptual decisions on what would otherwise seem as a simple empirical finding (in this case, high levels of comorbidity), and that this result seems to be achieved in any case, thus minimizing the importance of a disagreement about the philosophical terms as a pure terminological dispute. Nevertheless, in my work the Kuhnian model had a significant role in the clarification of this matter and it also suggests to the reader a range of possible consequences that are not trivial (Zachar, for example, says to be skeptical about the possibility of a crisis and also about the possibility that a new paradigm could eliminate what I call the [End Page 29] comorbidity anomaly). As a consequence, some of the Kuhnian concepts that seemed to be at odds in this context have to be considered in detail to justify my analysis and its consequences. For reasons of space, I avoid a point-by-point reply to all the comments and I concentrate my discussion on three main points. First, I discuss the background of Kuhn's definition of terms such as anomaly and paradigm, as well as my own reasons for using them. In doing so the details of the psychiatric items under study that I wanted to highlight through the use of these philosophical concepts should emerge more clearly. Second, I discuss the problem of having distinguished between artifactual and real comorbidity. Third, I reconsider some of these problems, looking for their implications for future psychopathological research.Anomalies and ParadigmsBanzato (2009) stresses that comorbidity cannot be a truly Kuhnian anomaly because it is an anticipated side effect of the initial setup of the DSM, and not some unexpected discovery that violates the paradigm-induced expectation. This is a basically correct account of the most known version of Kuhnian anomalies; that is, the tale of some evident nature's failure to conform to clear paradigm expectations, which immediately forces researchers to recognize its importance as a possible source of crisis. However, as is the case for many other Kuhnian terms, he discussed anomalies in several scripts and there are other possible versions of its meaning. In particular, Kuhn (1977, XVII) highlighted that only in very rare cases are anomalies completely unexpected and come out of blue to announce an imminent crisis that leads to a large revolution. More frequently, scientific revolutions are much more smaller, like the discovery of oxygen, and in these cases the process is so gradual that historians find it difficult to say exactly when a discovery was made and who did it. Even in these much smaller cases the usual prelude to changes of this sort is the awareness of anomaly, but here anomalies are not extraordinary events; rather, they are "countless discrepancies between theory and experiment [that] during the course of his career, every natural scientist again and again notices and passes by" (Kuhn...

In view of the publication of the DSM-V researchers were asked to discuss the theoretical implications of the definition of mental disorders. The reasons for the use, in the DSM-III, of the term disorder instead of disease are considered. The analysis of these reasons clarifies the distinction between the general definition of disorder and its implicit, technical meaning which arises from concrete use in DSM disorders. The characteristics and limits of this technical meaning are discussed and contrasted to alternative definitions, like Wakefield’s harmful/dysfunction analysis. It is shown that Wakefield’s analysis faces internal theoretical problems in addition to practical limits for its acceptance in the DSM-V. In particular, it is shown that: a) the term dysfunction is not purely factual but intrinsically normative/evaluative; b) it is difficult to clarify what dysfunctions are in the psychiatric context (the dysfunctional mechanism involved being unknown in most cases and the use of evolutionary theory being even more problematic); c) the use of conceptual analysis and commonsense intuition to define dysfunctions leaves unsatisfied empiricists; d) it is unlikely that the authors of the DSM-V will accept Wakefield’s suggestion to revise the diagnostic criteria of any single DSM disorder in accordance with his analysis, because this is an excessively extensive change and also because this would probably reduce DSM reliability. In conclusion, it is pointed up in which sense DSM mental disorders have to be conceived as constructs, and that this undermines the realistic search for a clear-cut demarcation criterion between what is disorder and what is not.

This paper presents the main contents of Geiger’s 1910 lecture on empathy and focuses on its possible influence on Jaspers’ General Psychopathology. In particular, some key methodological distinctions traced by Jaspers are compared to Geiger’s similar concepts. Geiger’s role in shaping Jaspers’ concept of understanding is still neglected and it is time to recognize it. In particular, Geiger’s distinction between the direct empathy for the other’s expressions at one side, and the ‘reliving after the event’ of the ‘inner correlation of the psyche’ on the other side had a major role in shaping Jaspers’ similar distinction between static and genetic understanding.

2013 sees the centenary of Jaspers' foundation of psychopathology as a science in its own right. The general sense of the General Psychopathology and its specific contribution are discussed. In particular, the lecture focuses on three major contributions: the methodological import (Jaspers perspectivism), the importance to study subjective experiences scientifically (Jaspers' phenomenology), and the concept of understanding. Three psychiatrists with partly different theoretical background discuss with the members of the Roman Circle of Psychopathology questions like: the specific historical and theoretical features of early Twentieth Century culture, science and psychiatry in Germany; Jaspers' relationship with other great thinkers of his time (Freud, Husserl, Heidegger, Kretschmer); the reception of the General Psychopathology in different countries; and the importance and limitations of Jaspers' approach for nowadays psychopathology.

Introduction: Obesity represents a major public health problem associated with medical and psychological impairment. Obesity is frequently studied with Binge Eating Disorder comorbidity. Less evidence is available for non-BED obesity, in spite of its correlation with psychological impairment and body image disturbance. In this study, we explored psychopathological features, eating behaviors, body image disturbance and self-identity impairment in patients with obesity and a control group. In patients, we also studied the relation between specific eating/body features and psychopathological symptoms. Finally, we explored the latent factorial structure that describes these features. Material and methods: The clinical sample was composed by twenty patients suffering from obesity without BED. The control group included twenty-eight healthy and normal-weight subjects enrolled from the general population. All participants underwent a clinical interview and filled out questionnaires about body image and psychopathological symptoms. Statistics: The Student t test was applied to compare obese patients and healthy controls in all psychological dimensions. In the clinical sample, gender differences were tested through multivariate analyses of variance. Then, correlational analyses explored the relation between specific eating/body features and psychopathological symptoms. Lastly, a principal-components factor analysis was performed to explore the existence of a latent factorial structure emerging from assessment evaluation in obese population. Results: Obese patients reported significantly higher scores than healthy controls in several psychopathological dimensions, i.e. Somatization, Obsessive-Compulsive, Depression, Hostility, Phobic Anxiety, and Psychoticism. Patients also reported higher body uneasiness and self-identity impairment resulting from some scores on Body Uneasiness Test and Identity and Eating Disorders questionnaire. Avoidant behaviours were more frequently reported in men whereas women reported higher body distress/dissatisfaction. In the clinical sample the questionnaires were correlated and a three-factor structure emerged: “Weight and body control”, “Weakness of Self-Identity”, and “Psychopathological distress”. Discussion: The present study found that obese patients might present several disturbances in body image, selfperception and general psychopathological distress. Clinicians should be aware of these issues to improve therapeutic strategy in the treatment of obesity.

Traditionally, the key features of the family system of Eating Disorders have been considered those originally outlined by Minuchin in his description of the "psychosomatic" family patterns of interaction. This controlled study tests two of the principal characteristics of Minuchin's model, namely enmeshment and rigidity, operationalised as extreme cohesion and low adaptability. Perceived and desired cohesion and adaptability, measured with the FACES III, were compared between 30 clinical families and 30 non-clinical families. Differences across ED family members were also considered, as well as differences between ED symptomatological subgroups . High cohesion scores were found in ED families, but similar findings were also reported in control families. Cohesion scores were significantly higher in restricting anorectics than in patients with bulimic symptoms. Adaptability was normal in both ED and control families. This study does not support Minuchin's observations on family enmeshment and rigidity. Although high levels of cohesion were found in ED families, the same relational pattern was found in the control families, suggesting that a tendency to a hyper-involvement of family members might be "normal" in some sociocultural contexts