How did it start
The book by Karl Jaspers General Psychopathology appeared in a Serbo-Croatian translation in 1978. That same year, I became a medical doctor and concentrated on becoming a psychiatrist. Therefore, it was “natural” for me to purchase it because it was considered a classic of psychiatric literature almost from the first day of printing in 1913. Since then, it has been published and revised on several occasions. I “met” Karl Jaspers in high school thanks to my good philosophy professor Momčilo Paraušić. He taught us about Jaspers’s contribution to philosophy. It was not until later that I learned that Jaspers was initially a psychiatrist in Heidelberg when he wrote the book that is the subject of this text.
I was first introduced to the subject of General Psychopathology during my psychology studies in 1976. Professor Popović often quoted Jaspers's book, so I knew about its existence and importance. I was not intimidated by the volume (more than 800 pages) and the difficulty in translating complex concepts from the German language, as well as the high objective of the book linked to the application of the phenomenological scientific method in the examination of the psychological life of patients.
My approach, though not yet fully formed, in working with patients and in thinking involved the extensive and thorough study of the human psyche, which includes not only the medical and psychological aspects but also the anthropological, sociological, and philosophical sides, this excellent book so masterfully conceived. In addition, the translation into the Serbo-Croatian language was done by one of the best-known psychiatrists in the region, Pavle Milekić. Even though I never met him personally, I was familiar with his work in adolescent psychiatry and his extensive translations of Freud’s and Jung’s books. Sadly, he died too soon, before the book was published. The reviewer was none other than Vladeta Jerotić. Because of all these reasons, I considered it a real treasure for which I gladly paid the then large sum of 600 dinars.
I didn't start reading right away. I was waiting for the right moment to give it the necessary attention and time. The period of my military life in Slovenia gave rise to this opportunity. In six months, I was able to “master” and mentally process the demanding material of this book, generously highlighting the text with colored wooden pencils.
This was the only professional book I carried with me to Slovenia. The decision, to “drag” this heavy book, testifies to my motivation to continue and deepen psychiatric knowledge and to prepare for future work with patients. Knowledge of psychopathology is the foundation on which the sculpture of a psychiatrist is built. The deeper, larger and stronger the base, the more stable the sculpture will be. That is why I was determined to dedicate myself to reading Jaspers’s book during the free time I had to spare during my military service in Slovenia.
The book of a philosopher
From the outset, it was clear that the book was written by a philosopher because the introduction is devoted to the delineation of basic concepts. For example, between humans and animals in relation to mental illness. According to Jaspers, human incompleteness and freedom of choice open the door through which elements leading down the way to mental disorders can infiltrate, which is not the case with animals because of their “vital primordial adaptability.” *
Another important discussion in the introduction concerns the difference between prejudices and assumptions. Jaspers believes that one should understand prejudices (philosophical, somatic, psychological, medical, and others) in order to become free of them by developing critical self-awareness, which is “an essential task in every chapter of this book.” * One of the young psychiatrists in Serbia, Srđan Jerotić, has written a long review on the subject of prejudice, based on an analysis of Jaspers's book. Jerotić's main contribution is that he illustrated each described prejudice with examples from clinical practice. Here is one of them. Three patients with neurological diagnoses (Parkinson's disorder, epilepsy, and stroke) complained of emotional lability and depressed mood. The psychologist wanted to talk to these patients about their experiences, but the psychiatrist opposed it because they were all diagnosed with an organic brain disorder, so the cause for their symptoms was determined and a conversation was pointless. ** The psychiatrist in this instance was clearly under the influence of bias known as biological reductionism, where all psychological phenomena are secondary to biological phenomena. Guided by this frequent prejudice, he ignored the psychological experiences of patients. In addition, with the authority of the title of Doctor of Medicine, he prevented the psychologist in his intention of comprehensive phenomenological examination and understanding. I also went through something similar early in my psychiatric residency in America. Eager to get to know the patients, I spent hours in conversation with them. The chief resident who was my supervisor complained that I spent too much time with the patients. He was likely operating under the influence of the prejudice that reigned then (and continues to reign now) in psychiatry, which states that a short description of symptoms is sufficient to establish an objective descriptive diagnosis, which then guides the treatment approach.
What about diagnosis
To continue the discussion above, I would like to highlight Jaspers's views on medical (psychiatric) diagnosis. He believes that it is the least important issue because, “The chaos of phenomena should not be blotted out with some diagnostic label but bring illumination through the way it is systematically ordered and related. Psychiatric diagnosis is too often a sterile running round in circles so that only a few phenomena are brought into the orbit of conscious knowledge.” * I agree with Jaspers on this subject. My experience has taught me that any psychiatric diagnosis is provisional, rather than an absolute category. Many times I have witnessed the “labeling” of patients and judgmental attitude towards them because of the “attached” diagnosis, which often not only does not assist in treatment, but also delays it, and sometimes leads to a nihilist approach in care. In my opinion, it is more important to take a two-pronged stance. One is pragmatic, due to administrative procedural tasks related to health insurance, leave of absence, disability, etc., where the diagnosis is necessary, and the other is substantive, which recognizes that diagnostic categorization is not the same as understanding the phenomenon it is supposed to represent. Let me continue on this important topic with another quote from Jaspers' book.
“What do we diagnose? … Diagnosis is expected to characterize in a comprehensive manner the whole morbid occurrence which has assailed the person, and which stands as a well-defined entity among others…. But however we devise [a diagnostic schema] we realize that it cannot work; that we can only make temporary and arbitrary classifications; that there are a number of different possibilities which account for the fact that different workers construct entirely different schemata; and that classification is always contradictory in theory and never quite squares with the facts.” *
The role of assumptions
Contrary to the prejudices that we have to get rid of, assumptions are necessary determinants that help us understand the reality of another person's psychological life. Jaspers believes (which modern science confirms) that the true assumptions are based on the understanding of the being of the psychopathologist and are conditioned by his perceptions and understanding. There is no dichotomy between subject and object (psychopathologist and patient). The subject affects the object with its presence. The relationship is a necessary link in the process of knowing and understanding. As I mentioned earlier, modern sciences, and above all quantum physics, talk about the fact that the process of observation itself changes the object of observation (at the quantum level, energy turns into the matter, a wave into a particle). This claim has far-reaching consequences. We are all immersed in the matrix of reality and influence each other in such a way that it is impossible to be an objective observer. It is far more accurate to say that the relationship determines what information and energy will be transmitted and received between two or more people.
The content of the book
And now, let me turn my attention to the main content of General Psychopathology. The book is divided into six parts. The first part deals with individual mental status phenomena. Anomalies of perception, the experience of space and time, awareness of one's own body, awareness of reality and delusions, attention and fluctuations of consciousness, and many other characteristics are described. This part is the most voluminous and includes almost 300 pages of text. Subjective experiences, objective peculiarities, and accompanying bodily changes are gradually and systematically presented.
The second and third parts are devoted to the connections of psychic life. The second part deals with “understandable” connections, in which certain phenomena are explained by psychopathologists taking into account the contributions of the humanitarian sciences, primarily psychology. Jaspers writes:
“In natural sciences, we find causal connections only but in psychology, our bent for knowledge is satisfied with the comprehension of quite a different sort of connection. Psychic events ‘emerge’ out of each other in a way that we understand. Attacked people become angry and spring to the defense, cheated persons grow suspicious.” *
The third part deals with causal explanations. The effects of the environment and the body on mental life, as well as genetic inheritance, are described. Here Jaspers provides a useful theoretical review of the strength and limitations of the causal explanatory method in psychiatry.
The fourth part is synthetic, looking at the whole of psychic life and the picture of the disease (nosology). Classification, symptom complexes, gender, constitution, and race, as well as the course of life (biography) are presented.
The fifth part examines mental illness from a sociological and historical point of view. The content and forms of manifestation of mental processes depend on the cultural milieu in which they occur. Here Jaspers briefly makes some comments about religion, mass psychology, war, and culture.
In the sixth part, we encounter the full manifestation of Jaspers as a philosopher with a self-critical review of his own conceptualization of psychopathology. He explains the question of the essence of man, the relationship between psychiatry and philosophy, the concepts of health and illness, as well as the meaning of practice. Jaspers writes: “The human being is an open possibility, incomplete and incompletable. Hence, he is always more and other than what he has brought to realization in himself.” * Lastly, he discusses the meaning of medical practice. Here, we read about Jaspers’s humanistic approach to patient care.
“The ultimate thing in the doctor-patient relationship is existential communication, which goes far beyond any therapy, that is, beyond anything that can be planned or methodically staged. The whole treatment is thus absorbed and defined within a community of two selves who live out the possibilities of Existence itself, as reasonable beings. Doctor and patient are both human beings and as such are fellow travelers in destiny.” *
Jaspers’s contributions
My generational American colleague S. Nassir Ghaemi summed up Jaspers's contribution to psychiatry in this way: “I believe that Karl Jaspers provided the most rigorously argued analysis of the scientific method in psychiatry. His contribution in this regard could be summed up in two main ideas: methodological pluralism and the understanding-explanation dichotomy.” *** Jaspers's position is that a human being can never be fully understood by one method of knowing. Therefore, all available methods must be utilized, and the pros and cons of each must be clearly understood. Methodological pluralism is about recognizing the advantages and limitations of each method and using the methods that are most appropriate for the particular circumstances and the patient. Jaspers's reflection on the difference between understanding and explanation is related to pluralism. By understanding, Jaspers signifies the “sense” or psychological intuition that the psychopathologist has about the patient's psychological state or event. By explanation Jaspers refers to the more traditional concept of causal empirical experience or the observable influence of one event or process on another that could be tested objectively. *** Jaspers warns us that we automatically observe reality through the lenses of one or another theoretical orientation. Therefore, we must make an ongoing conscious effort to discard the theoretical prejudices that are always present in our minds and to train ourselves in a pure appraisal of the facts.
This attitude can be expanded from understanding psychopathological phenomena to everyday life for each of us. That is, we are all “hypnotized” by what was taught to us in the first five to seven years of life. Then our basic behavioral patterns, “programs”, core beliefs, and emotional tone are established so that our later life unfolds as guided by these “theoretical” biases. If we don't wake up to these “lenses” and make a huge effort to, first of all, notice them and then take them off, we will unconsciously manifest a set of behaviors that repeat embedded programs in a rigid manner without the critical thinking that is necessary for true freedom of choice.
Following this digression, I return to Jaspers. In this book, he applied the method of phenomenology - direct research and description of phenomena that patients consciously experience without relying on theories about their cause. General Psychopathology emphasizes the psychological understanding of mental disorders as narrative and contextual phenomena, predicting the so-called person-centered medicine. This person-centered approach helps us see patients as creators rather than passive recipients, as participants in their own healing through self-understanding of not only pathological but also potentially adaptive psychological phenomena.
Jaspers's book is demanding. It is not suitable for people who want simple “recipes” that will guide them towards becoming a psychiatrist. To explain it a bit more, I will try to express myself figuratively, perhaps even with a flair for drama. I believe Jaspers is asking us to consciously jump into the ocean of human existence, where we see a drowning man barely afloat and in need of our help. Our decision is guided by an intense emotion of compassion and a desire to understand and share the experience of the sufferer. But even so, we must preserve the presence of the mind so that we do not go down with him when we give him the hand of salvation. He must feel and accept our hand with trust and surrender, as well as find the strength in himself to stay afloat and swim with us to the shore and the safety of the solid ground.
The book and me
I intuitively felt the importance of this book when I first read it during the long days and nights of my military service. I admired the richness of the linguistic repertoire and the “philosophizing” liberated from abstraction and orientated towards another person. I sensed the immediacy and dedication of a humanist who approaches the study of psychopathology in a genuine manner. This brought to mind the humanist psychology of Maslow, Rogers, and Fromm, which I studied during my years of psychology. Therefore I continued to associate myself with this valuable book to this day. It was one of three books that I carried with me to America, and which accompanied me in all my migrations. Today, it holds a place of honor in the “sunroom” of my home in Arizona.
In my academic career as a lecturer, I frequently returned to Jaspers for a course that I have taught to psychiatric residents over the years. At the end of my “official” career, I decided to write a manual that I handed to the director of the residency program. I dedicated it to serving future generations of residents. In the introduction, I have tried to communicate the spirit of the Jaspers book with these words:
“In descriptive psychopathology, empathy is used as a clinical tool to understand and describe another person’s internal subjective state using precise and knowledgeable questioning. Apart from empathy, additional skills needed by descriptive psychopathologist are accurate observation of behavior and attentive and focused listening.” ****
I think Jaspers has contributed to psychiatry in many ways, primarily due to the introduction of the phenomenological approach as the most suitable scientific method to examine subjective experience and empathy as the most effective way to understand that experience. With this text, I wanted to express my appreciation for Jaspers and his magnum opus, which is so important in the formation of the sculpture of a psychiatrist in me.
* Opšta psihopatologija, Karl Jaspers, Prosveta i Savremena Administracija, 1978
** Jerotic, S. Prejudices in the psychopathologist: Karl Jaspers’ heritage. Eur Arch Psychiatry Clin Neurosci 271, 1193–1200 (2021).
*** The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness, by S. Nassir Ghaemi, John Hopkins University Press, 2007
**** Manual for descriptive psychopathology, by Zelko Leon, unpublished manuscript, 2018
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