Načela fenomenološke psihiatrije in njena uporaba na primeru čustvenega doživljanja pri pacientih s prvo epizodo psihotične motnje

Borut Škodlar, Vid Vodušek, 20. 11. 2013

Zaradi gostov iz tujine bo seminar potekal v angleškem jeziku.
The seminar will be held in English.

Fenomenološko raziskovanje v psihiatriji

Phenomenological research in psychiatry

Doc. dr. Borut Škodlar, dr. med.

Povzetek v slovenščini
Fenomenološko raziskovanje je v psihiatrijo in v preučevanje psiho(pato)loških pojavov uvedel Karl Jaspers, ki je v svojem vélikem in metodološko še vedno zelo pomembnem delu Splošna psihopatologija začrtal raziskovanje psihopatoloških stanj. Jaspersovo metodo so dopolnjevali in nadaljevali raziskovalci, ki so se metodološko naslonili na fenomenologijo Edmunda Husserla. Z njeno pomočjo je možno prodirati onkraj vsebin, torej onkraj vprašanja, »kaj« je posamezno izkustvo, k njegovemu »kako«, to je k strukturnim značilnostim takšnega izkustva. Premik od »kaj« h »kako« imenujemo fenomenološka redukcija.

V fenomenološkem raziskovanju skušamo najprej ozavestiti in potem tekom raziskave spremljati svoje predsodke, vnaprejšnja vedenja in prepričanja, ki jih omejimo s fenomenološkim epoche ter s tem omejimo njihov vpliv na naše raziskovanje. Natačne opise pacientovih doživljanj obravnavamo enakovredno in torej brez vnaprejšnjih sodb. S tako enakovredno razvrščenih izjav/opisov v naslednjem koraku razberemo nespreminjajoče in neprekrivajoče sestavine preučevanega izkustva.

Sledi faza raziskovanja tako »razgrnjenih« izkustev iz različnih perspektiv s pomočjo t.i. eidetične variacije ter se preko nje prebiti k strukturnim značilnostim izkustev (torej k njihovim »kako«). Takšne strukturne značilnosti so npr. časovnost, prostorskost in telesnost izkustva, odnos do sebe in do drugih itn. Poleg tega je potrebno svoja odkrivanja in korake na poti eidetičnega raziskovanja medsebojno preverjati pri drugih raziskovalcih, kar imenujemo intersubjektivna validacija. S tem postaja raziskovanje preverljivo in ponovljivo.

Tako pridobljene ugotovitve o subjektivnem doživljanju izkustev, ki so plod takšnega sistematičnega in preverljivega postopka, pa so lahko pomemben doprinos tudi k nevroznanstvenem preučevanju psihopatoloških izkustev. Dobre fenomenološke raziskave preučevanih izkustev so namreč nujen predpogoj za kvalitetno nevroznanstveno raziskovanje, katerega odličen primer je nevrofenomenologija.

Abstract in English
Phenomenological research was introduced to psychiatry and to the study of psycho(patho)logical phenomena in general by Karl Jaspers, who outlined the research of psychopathological states in his great and methodologically still very important work General Psychopathology. Jaspers’s method was later further developed by other investigators, basing their methodology also on the phenomenology of Edmund Husserl. The method allows us to move beyond the content (the “what”) of our experiences to their structural characteristics (the “how”). The shift from the “what” to the “how” is called phenomenological reduction.

Phenomenological research begins by bringing our prejudices, prior knowledge and beliefs into awareness. These are then monitored while their influence on the research is restricted with the phenomenological epoché. From the patient we subsequently solicit thorough descriptions of her experiences which we then treat equivalently and without prior judgment. The next step consists of extracting unchanging and non-overlapping components of the studied experience.

The following phase relies on the so-called eidetic variation in order to look at the studied experiences through the lenses of different perspectives with the goal of discovering their structural characteristics, such as the temporality, spatiality and embodiment of experience. An integral part of eidetic research (called intersubjective validation) is discussing its procedure and findings with other researchers, which allows the research to become repeatable and testable.

Discoveries that follow from this kind of systematic research can provide an important contribution to the neuroscientific research of psychopathological experience, since a good understanding of the phenomenology of the researched phenomena is one of the prerequisites for quality neuroscientific research (an excellent example being neurophenomenology).

Uporaba fenomenološke psihiatrije na primeru čustvenega doživljanja pri pacientih s prvo epizodo psihotične motnje

Phenomenological psychiatry in the case of emotion experience in first episode psychosis

Vid Vodušek, univ. dipl. psih.

Povzetek v slovenščini
Motnje v doživljanju in regulaciji čustev igrajo pomembno vlogo v psihopatologiji motenj shizofrenskega spektra, še posebej pa pri negativni simptomatiki. Boljše razumevanje fenomenologije motenj čustvovanja in učinek teh motenj na osebno zgodbo in socialno funkcioniranje je ključnega pomena za ustrezno obravnavo in rehabilitacijo.

Poglobljeni intervjuji so bili izvedeni z dvajsetimi pacienti s prvo epizodo psihotične motnje. Pri zbiranju in analizi podatkov sta avtorja sledila načelom fenomenološkega raziskovanja subjektivnih izkušenj.

Udeleženci poročajo o tesnobi kot o osnovnem čustvu, ki duši, preobraža in občasno nadomešča vsa druga čustvena stanja. Čustva so na splošno doživeta kot tuje, nestabilne in moteče subjektivne izkušnje, ki pomembno prispevajo k občutkom ambivalence in zbeganosti ter k nestabilnosti občutka za sebe na splošno. Zmanjševanje tesnobe v kontekstu varnega in zaupnega terapevtskega odnosa igra ključno vlogo pri prepoznavanju subjektivnih čustvenih stanj in smiselnem umeščanju le-teh v osebno zgodbo.

V tej študiji opisane specifike čustvovanja pri osebah s prvo psihozo se smiselno povezujejo s pervazivno ambivalenco, zbeganostjo in temeljno nestabilnostjo občutka za sebe, ki predstavljajo ključne gradnike shizofrenske psihopatologije. Nestabilnost čustvenih izkušenj neugodno vpliva na koherentnost in integriranost osebnih zgodb in samo-razumevanja pacientov ter posledično tudi na njihovo socialno funkcioniranje. Varen in zaupen psihoterapevtski odnos pomaga pri stabilizaciji čustvenega doživljanja in oblikovanju koherentne osebne zgodbe ter tako pomembno prispeva k procesu okrevanja.

Abstract in English
Disturbances in emotion experience and regulation are important aspects of the psychopathology of schizophrenia spectrum disorders, especially the negative symptomatology. A better understanding of the phenomenology of emotional disturbances and of their impact on personal narrative and social functioning is crucial for adequate treatment and rehabilitation.

In-depth interviews were conducted with twenty first episode psychosis patients. Data collection and analysis were guided by the principles of phenomenological study of lived experience.

Anxiety is reported as the basic emotion which buffers, transforms and sometimes supplants all others. Emotions in general are experienced as foreign, unstable and perturbing subjective experiences, which contribute greatly to feelings of ambivalence, perplexity and an unstable sense of self in general. The reduction of anxiety in the context of a safe and confidential therapeutic relationship seems to play a crucial role in recognizing subjective emotional states and their integration in personal narrative.

The specific emotionality described in this study can be meaningfully tied to phenomena of ambivalence, perplexity and an unstable sense of self, which represent core dimensions of schizophrenic psychopathology. The instability of emotion experience negatively impacts the coherence and integrity of patients’ personal narratives, their self-understanding and consequently their social functioning. A safe and confidential psychotherapeutic relationship helps in the stabilization of emotional experiences and the construction of a more coherent personal narrative, thereby improtantly contributing to the process of recovery.

Informativni poster si lahko pretočite tukaj. Poster can be downloaded here.


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