Delusion

Abstract

In delusional research the combination of descriptive and understanding aspects is characteristic for the clinical psychopathology. For this junction the psychopathologist is always at the same time a distant and a participating physician, who on the one side observes and notices symptoms of the delusional psychosis, on the other side tries to understand "how psychic arises from other psychic with evidence". Important is the phenomenological attitude ("Phänomenologische Einstellung") through which the clinician tries by means of psychopathological exploration to describe the delusional experiences of the patient guided by his or her self-reports. In this way it is possible to discover understandable connections from the healthy person to the delusional one and to show why regarding a distinct personality and biography the delusion looks just as it looks and each patient forms the delusion in his or her typical individual manner. The final stages of delusional perception ("Wahnwahrnehmung") cannot be achieved without the "delusional processing" ("Wahnarbeit"), without processes of working up using the material of the whole life history. In active stages of psychotic phases often certainty of delusion ("Wahngewißheit") with regard to ego-reference can be found, but no certainty and constancy regarding to distinct concrete meanings. The ability to correct concerns more the component of the delusional perception understandable from the biography, than the somatic component, the basic disturbances, underlying the self-reference. Already because of the variance of concretizations it is not possible to comprehend the fully developed delusional perception in which the patient does not reach clarity and transparency as a through the "hold in concrete" won reassurance (Binswanger - [3, 44, 55, 70]). The concretizations are an expression of the process of working up, belonging to the human being as human being ("amalgamation with the anthropological matrix" - [91]), and not to the delusional disease process as such. Descriptive psychopathology tries to establish the terminology around delusional symptoms. The clinician should use the full range of language to describe and depict, what the patients have reported on their delusional experiences. Only as a secondary step we should try to catch the findings in a net of classified delusional symptoms and to sort them out into the plainest possible terms. Mistaken diagnoses in delusion come about because there has been too great a hurry to overlay the actual findings with some technical terminology. © Universitätsverlag Winter 2009.