Made available in DSpace on 2016-04-04T18:28:06Z (GMT). No. of bitstreams: 1 Joao Orlando McCaffrey Busnardo.pdf: 576637 bytes, checksum: 9fc1296c397f72df0a3c9855380a018c (MD5) Previous issue date: 2012-02-29 / The objective of this dissertation is to investigate the contributions of D. W. Winnicott to the field of psychoanalytic nosography. Nosography here is understood to be the classification and description of illnesses. This study takes for granted that the comprehension, characterization and visualization of diverse pathological manifestations, when related to diagnostics, are fundamental instruments for clinical practice. Initially, a brief historical review of the nosographic aspects associated with mental illness in psychiatry (Ellenberger, Ey and Foucault) and psychoanalysis (Freud and Klein) will be carried out. In the field of psychiatry, it can be shown that the grouping of symptoms is the basic principle for the classification of illnesses, whereas in the psychoanalyses of Freud, the same role is attributed to the dynamics of objectal relations in the management of sexuality. Further on, the principle proposals of Winnicott for the reformulation of the psychoanalytic theory of affective development and maturation are highlighted. Based on that theory, the diverse re-descriptions and additions to psychoanalytic nosography proposed by Winnicott will be described. Two different moments can be discerned: Winnicott when commenting and expanding aspects associated with traditional psychoanalytical nosography based on his own theories and Winnicott when annunciating new nosographic aspects with are complementary to that nosography. These two moments reveal his conception of human psychic suffering in aspects such as: relative integration and maturation, distortions in the environmental provisions, the false-self and its gradations, the feeling of being alive and real, relations of dependency and the consideration of persons that were environmentally provided for and persons that suffered environmental privation and deprivation. / O objetivo desta disserta??o ? explicitar as contribui??es de D. W. Winnicott para o campo da nosografia psicanal?tica, entendendo-se por nosografia a classifica??o e a descri??o das doen?as. Inicialmente, a compreens?o, caracteriza??o e visualiza??o das diversas manifesta??es patol?gicas ps?quicas relacionadas ao diagn?stico apresentam-se como ferramenta fundamental para a pr?tica cl?nica psicoter?pica, sendo esta constata??o a fundamenta??o inicial do conte?do aqui exposto. Para isso, faz-se uma breve revis?o hist?rica sobre os aspectos nosogr?ficos associados ? doen?a mental na psiquiatria (Ellenberger, Ey e Foucault) e na psican?lise (Freud e Klein). No campo da psiquiatria, percebe-se que o agrupamento de sintomas ? o acorde principal para a classifica??o das doen?as; enquanto que, na psican?lise de Freud, o mesmo papel ? atribu?do ?s din?micas das rela??es objetais no contexto da teoria da sexualidade. Em seguida, s?o destacadas as principais propostas de Winnicott, na sua reformula??o da teoria psicanal?tica do desenvolvimento - ou amadurecimento - afetivo. Fundamentando-se em tal teoria, espera-se colocar em destaque as diversas redescri??es e acr?scimos propostos por Winnicott na compreens?o da nosografia psicanal?tica. Evidenciam-se, ent?o, dois diferentes momentos: Winnicott comentando e expandindo, a partir de seu corpo te?rico, aspectos associados ? nosografia psicanal?tica tradicional e Winnicott enunciando novos aspectos nosogr?ficos complementares ?quela - revelando, deste modo, sua concep??o do sofrimento ps?quico humano. Dentre os aspectos acrescentados por Winnicott, est?o: a integra??o e a matura??o relativas, as distor??es na provis?o ambiental, o falso-self e suas grada??es, o sentir-se vivo e real, as rela??es de depend?ncia e a considera??o de pessoas que foram providas, privadas e/ou deprivadas.

Le concept de structure clinique se réfère immédiatement à la classification d’une maladie mentale comme névrose, psychose ou perversion, mais aussi au sous-type nosographique la concernant. Actuellement, les développements de ce concept constituent la principale théorie psychopathologique de l’analyse lacanienne. Toutefois, il y a une disparité de jugement sur sa valeur : (1) quelques auteurs soutiennent une continuité naturelle entre cette théorie et la doctrine de Freud et Lacan ; (2) quelques autres proposent une réorganisation de la nosographie psychanalytique incluant des nouvelles pathologies ; (3) quelques autres, finalement, défendent la disparition complète de ces références théoriques dans la clinique.Cette disparité relève d’une lacune dans le savoir : les fondements des structures cliniques, ainsi que ses enjeux, n’ont pas été encore systématisés. L’objetctif général de ce travail fut de les restituer, afin de déterminer la légitimité de cette théorie en tant qu’interprétation de la pensée de Freud et Lacan, ainsi que sa pertinence dans les débats psychopathologiques actuels.Pour éclairer les filiations symboliques qui soutiennent le concept de structure clinique, une méthode généalogique a été employée. Les résultats démontrent que Freud a utilisé une notion de structure héritée de la science du XIX e siècle pour élaborer ses conceptions psychanalytiques. La référence minéralogique, fournie par son ancien professeur G. Tschermak, a notamment imprégné l’usage freudien de la structure en psychopathologie. Bien que les catégories de névrose, psychose et perversion n’arrivent pas chez lui à se constituer comme un triptyque, il y a dans ses textes une tendance à les considérer dans leurs rapports mutuels, en tant que perturbations de la vie sexuelle. Cette tendance a été récupérée par Lacan à partir de 1953, et déclinée sur son concept de structure – entendue alors comme un ensemble covariant de signifiants – et sur les registres du réel, du symbolique et de l’imaginaire. Les avancées de sa production intellectuelle, telles que l’invention de l’objet petit a et l’introduction des nœuds et des tresses en psychanalyse, auront apporté jusqu’à la fin de ses jours un approfondissement du triptyque freudien.La systématisation de la théorie des structures cliniques a proprement commencée en 1981, quand les membres du Champ freudien ont soudé cet ensemble d’éléments psychopathologiques avec le terme, homonyme et préexistant, de structure clinique. L’enjeu majeur de cette soudure a été de supporter la relation dialectique entre la théorie et la pratique analytique. À présent, le programme de recherche des structures cliniques porte sur les psychoses ordinaires et sur la spécificité de l’autisme. La psychopathologie lacanienne ainsi constitué est interrogée depuis nombreux angles : la proposition d’une structure psychosomatique, la promotion des pathologies borderline, la liquidation post-moderne de la structure perverse, la contrainte des nosographies opérationnalisées (CIM, DSM et PDM). Les conclusions de cette recherche qualifient la théorie des structures cliniques comme une interprétation légitime de la pensée de Freud et de Lacan. Elle est d’autant plus pertinente dans le contexte actuel qu’elle est d’une grande utilité pour l’établissement du diagnostic structural, pour la direction de la cure et pour la transmission du cas clinique. En tant que cartographie du malaise subjectif, la structure clinique signale la référence éthique du psychopathologique, et constitue une résistance et une subversion face à la défaillance contemporaine dans l’appréhension du réel clinique. / The concept of Clinical Structure concerns the classification of a mental disease as neurosis, psychosis or perversion, and its corresponding nosographic sub-type as well. Nowadays, the developments of this concept constitute the main psycho-pathological theory brought about by lacanian psychoanalysis. However, there is a disparity of judgment regarding its value: (1) some authors assert the natural continuity between that theory and the doctrine of Freud and Lacan; (2) some others propose a reorganization of psychoanalytic nosography which includes new pathologies; (3) some others finally advocate a complete disappearance of these theoretical references from clinical studies. This disparity takes on a lack of knowledge: the clinical structures’ foundations, and its stakes, have not yet been systematized. The main objective of this work was to restore them, in order to determine the legitimacy of this theory as an interpretation of Freud’s and Lacan’s thinking, and its appropriateness in contemporary psycho-pathological debates.For clarifying the symbolic filiations that support the concept, a genealogical method has been employed. The results demonstrate that Freud has used a notion of structure inherited from 19th century science to elaborate his psychoanalytical conceptions. The mineralogical reference, provided by his ancient Professor G. Tschermak, has notably permeated the freudien use of the structure in psychopathology. Although he did not constitute the categories of neurosis, psychosis and perversion as a triptych, there is in his textes a tendancy to consider them on their mutual connections, as disturbances of sexual life. This tendancy has been recovered by Lacan since 1953, and declined on his concept of structure (then understood as a co-variant set of signifiers) and on the registers of real, symbolic and imaginary. The advances of his intellectual production, like the invention of the Object petit a and the introduction of knots and braids in psychoanalysis, have brought until the end of his days a deepening of the freudien triptych.Systematization of the theory of clinical structures has properly started in 1981, when the members of the Freudien Field have welded this set of psycho-pathological items to the term, namesake and pre-existing, of clinical structure. The major stake of this welding has been to support the dialectical relationship between the psychoanalytic theory and the practice.Nowadays, the in-depth study of clinical structures is focused on the ordinary psychosis and the specificity of autism. The Lacanian psychopathology thus constituted is questioned from many angles: the proposition of a psychosomatic structure, the promotion of borderline pathology, the Postmodern liquidation of the perverse structure, the constraint of operationalized nosographies (ICD, DSM and PDM).In conclusion, this research confirms the theory of clinical structures as a legitimate interpretation of Freud’s and Lacan’s thinking. It is even more relevant in contemporary context that it has an important utility in order to the establishment of structural diagnose, to the direction of the cure and to the transmission of cases. As a cartography of subjective discomfort, the clinical structure points to the ethical reference of the psycho-pathological, and constitutes a resistance and a subversion facing the contemporary failure in the apprehension of clinical real.

La recherche que nous avons développée dans notre thèse a eu pour objectif l’étude des psychoses dissociées à travers une approche clinique et projective comparées. C’est à travers une révision de la littérature des psychoses, que nous avons, dans un premier temps, mis en évidence les diverses positions au sein de la nosographie psychiatrique dans un contexte historique, puis actuel. Nous avons croisé cette perspective à une approche issue de l’application du modèle métapsychologique, dont les jalons ont été posés par Freud (1911, 1920, 1924, 1940). En outre, nous avons mis en évidence une opposition entre Freud et Bleuler à travers leurs échanges épistolaires parus en 2016, et cela à propos de la question de l’autisme. La recherche que nous avons conduite est composée de plusieurs études. La première étude vise la comparaison statistique des indicateurs au test de Rorschach (Nina Rausch de Traubenberg, 1990) entre la population tout-venant ([n=310], (de) Tychey et al., 2012) et entre la population psychiatrique psychotique (n=81). Tous les diagnostics ont été réalisés en double aveugle au test de Rorschach et selon une double approche nosographique dans la clinique (psychanalytique et psychiatrique). La seconde étude est une analyse qualitative contrastée, constitué de 5 cas cliniques, consacrée à une investigation approfondie des psychés de cas cliniques exemplaires représentatifs des trois sous-groupes de référence de la population de l'étude. La troisième étude est longitudinale sur un cas clinique à 24 mois d’intervalles en test/re-test nous permettant de valider la fiabilité du diagnostic de paranoïa, dont nous assistons pourtant à l’évanouissement nosographique.Pour conclure, nous avons dégagé et validé l’indicateur de la représentation de soi intitulé : le degré de représentation de soi entière unitaire, qui permet notamment de discriminer les structures et les organisations entre elles. La psychose dissociée, reconnue pour représenter la faillite du narcissisme primaire est apparue comme une population adéquate au développement de ces travaux sur l’évaluation du narcissisme / It is thought a depth psychosis literature review, that we have, in a first time, highlighted various positions within the psychiatric nosography, in an historic and then, in a current context. We cross a perspective called objective to an approach more subjective, however very rewarding: the metapsychological model, whose milestones were thrown by Freud (1911, 1920, 1924, 1940). In addition, we highlighted an opposition between Freud and Bleuler thought their epistolary exchanges published in 2016 in French. This about, question of autism that Freud (1911) designated as well as a retreat of the libido on the Ego; contrarily to Bleuler (1911). To us, that epistemological and theoretical cleavages, have influenced the current nosography (DSM-5, A.P.A., 2013). The empirical research developed in this thesis, aimed at the study of dissociated psychosis through a clinical and projective compared approaches. Indeed, this research is composed by many studies: the first was aimed at the statistical comparisons of Rorschach’s indicators (Nina Rausch de Traubenberg, 1990) between non-clinical population ([n= 310], (de) Tychey et al., 2012) and clinical population, psychiatrist, and more specifically: psychosis dissociated ([in]patient [n= 81]). Within the first study, in a second time, we proceeded to the statistical comparisons between the three subgroups of the sample, constitute of: 25 subjects diagnosed with paranoia, 30 subjects diagnosed with schizophrenia and 26 diagnosed with paranoid schizophrenia. All diagnostics were realized in double bind et and according to a double approach (psychoanalytic and psychiatrist). The second study is a qualitative analysis contrasted, devoted to the deeply psychic investigation of exemplary clinical cases, representatively of three subgroups from the population’s study (paranoia; schizophrenia paranoid; pure schizophrenia). The sample is itself constituted of limits’ subgroups suffering from psychotic decompensations and hospitalized on a long court. In the qualitative study of clinical contrasted cases, we presented firstly, a subject from a pure paranoia structure: Catherine, an autopunitive feminine paranoia case.Secondly, we presented the analysis of a clinical picture from schizophrenic structure: Joseph, from which megalomaniac Ego and invasive delirium will surely arrested the lector; and finally, we analysed a pure schizophrenia case: Doug, which psychic desert particularly challenges us in conter-transferential’s dynamic. Then, to illustrated closer that we understand by sliding of an a-structure to a dissociated psychosis (and not to a melancholic proceed, as well as that is permitted by Bergeret [1974]), we analysed the cases of Jordan and Ali. Ali was initially inscribed in an a-structure (Bergeret, 1974), from which he decompensed secondarily in a paranoiac organisation; Jordan on other hands, decompensed secondarily in a pure schizophrenia

L’existence d’un sous-type dissociatif de schizophrénie a été suggérée par plusieurs auteurs pour rendre compte des présentations symptomatologiques d’un groupe de personnes dont le diagnostic principal est dans le spectre de la schizophrénie mais qui présentent aussi des symptômes dissociatifs (Ross, 2004; Şar et al., 2010; Van der Hart, Witztum, & Friedman, 1993). D’origine traumatique, ce type de portrait clinique où symptômes psychotiques et dissociatifs s’entremêlent aurait été décrit il y a déjà plus d’un siècle (Janet & Raymond, 1898) mais serait disparu dans les années ’30, assimilé au concept de « schizophrénie » (Rosenbaum, 1980). C’est dans un nouveau contexte nosographique que le concept de schizophrénie dissociative refait surface. En effet, la nosographie psychiatrique a pris un tournant en 1980 lorsque l’approche préconisée par le DSM est devenue descriptive plutôt que basée sur des conceptualisations psychanalytiques. Du coup, les affections d’alors ont été divisées en troubles dont les symptômes ont tendance à se manifester ensemble (Cooper, 2004) et la comorbidité entre les troubles a augmenté. Étant donné la comorbidité fréquemment rapportée entre les troubles psychotiques et dissociatifs, la similarité phénoménologique de leurs symptômes, ainsi que leur possible étiologie traumatique, Ross (2004) a proposé une série de critères permettant de diagnostiquer une schizophrénie dissociative. L’objectif principal de cette thèse est donc d’établir si la schizophrénie dissociative, telle que définie par Ross (2004), existe. Le premier article porte sur la problématique et le contexte théorique ayant mené à la question de recherche. Il vise à faire un survol des enjeux entourant la question de la schizophrénie dissociative et rend compte des écrits scientifiques sur la symptomatologie similaire entre les troubles psychotiques et dissociatifs, sur leur étiologie traumatique et sur les études sur la dissociation et la schizophrénie. Le deuxième article est quant à lui un article empirique rendant compte de la méthodologie utilisée pour répondre à la question de recherche. En effet, aucune étude jusqu’ici n’a testé systématiquement les critères de la schizophrénie dissociative. Nos résultats démontrent que 24% de notre échantillon (N=50) pourrait recevoir le diagnostic de schizophrénie dissociative avec les critères proposés par Ross (2004). Toutefois, ces critères posant problème, une modification a été proposée et une prévalence de 14% a alors été trouvée. Des vignettes cliniques sont présentées afin de comparer nos participants avec ceux rapportés ailleurs. Les liens entre symptômes psychotiques et dissociatifs sont discutés en essayant de conceptualiser la schizophrénie dissociative de différentes manières, soit comme une nouvelle entité clinique, comme un trouble comorbide ou dans un contexte nosographique psychodynamique. / The existence of a dissociative subtype of schizophrenia has been suggested by several authors to account for the symptomatology of a group of people whose primary diagnosis is in the schizophrenia spectrum but have in addition dissociative symptoms (Ross, 2004; Sar et al, 2010; Van der Hart, Witztum, & Friedman, 1993). Of traumatic origin, this type of clinical picture where psychotic and dissociative symptoms are intertwined was first described more than a century ago (Janet & Raymond, 1898) but disappeared in the 30’s, having been incorporated to the concept of "schizophrenia" (Rosenbaum, 1980). It is in a new nosographic context that the concept of dissociative schizophrenia resurfaced. Indeed, psychiatric nosography took a turn in 1980 when the approach advocated by the DSM became descriptive rather than based on psychoanalytic conceptualizations. The psychiatric conditions of the time were divided into disorders whose symptoms tended to occur together (Cooper, 2004). Consequently, the presence of comorbid disorders increased. Given the frequently reported co-occurrence of psychotic and dissociative disorders, the phenomenological similarity of their symptoms and their potential traumatic etiology, Ross (2004) proposed a criteria set for the diagnosis of dissociative schizophrenia. The main objective of this thesis is to determine whether the dissociative schizophrenia, as defined by Ross (2004), exists. The first article focuses on the problem and the theoretical background that led to the research question. It aims at providing an overview of the issues surrounding the question of dissociative schizophrenia. It also reports on the literature pertaining to symptoms found in both psychotic and dissociative disorders, their traumatic etiology and studies on dissociation and schizophrenia. The second article is of empirical nature and reports the methodology used to answer the research question. Indeed, no study to date has systematically tested the criteria for dissociative schizophrenia. Our results show that 24 % of our sample (N = 50) could receive a diagnosis of schizophrenia with dissociative criteria proposed by Ross (2004). However, the criteria set was problematic so a modification was proposed and a prevalence of 14% was then found. Clinical vignettes are presented to compare our participants with those reported elsewhere. The links between psychotic and dissociative symptoms are discussed in trying to conceptualize dissociative schizophrenia in different ways, either as a new clinical entity, as a comorbid disorder or in a psychodynamic nosographic context.

L’existence d’un sous-type dissociatif de schizophrénie a été suggérée par plusieurs auteurs pour rendre compte des présentations symptomatologiques d’un groupe de personnes dont le diagnostic principal est dans le spectre de la schizophrénie mais qui présentent aussi des symptômes dissociatifs (Ross, 2004; Şar et al., 2010; Van der Hart, Witztum, & Friedman, 1993). D’origine traumatique, ce type de portrait clinique où symptômes psychotiques et dissociatifs s’entremêlent aurait été décrit il y a déjà plus d’un siècle (Janet & Raymond, 1898) mais serait disparu dans les années ’30, assimilé au concept de « schizophrénie » (Rosenbaum, 1980). C’est dans un nouveau contexte nosographique que le concept de schizophrénie dissociative refait surface. En effet, la nosographie psychiatrique a pris un tournant en 1980 lorsque l’approche préconisée par le DSM est devenue descriptive plutôt que basée sur des conceptualisations psychanalytiques. Du coup, les affections d’alors ont été divisées en troubles dont les symptômes ont tendance à se manifester ensemble (Cooper, 2004) et la comorbidité entre les troubles a augmenté. Étant donné la comorbidité fréquemment rapportée entre les troubles psychotiques et dissociatifs, la similarité phénoménologique de leurs symptômes, ainsi que leur possible étiologie traumatique, Ross (2004) a proposé une série de critères permettant de diagnostiquer une schizophrénie dissociative. L’objectif principal de cette thèse est donc d’établir si la schizophrénie dissociative, telle que définie par Ross (2004), existe. Le premier article porte sur la problématique et le contexte théorique ayant mené à la question de recherche. Il vise à faire un survol des enjeux entourant la question de la schizophrénie dissociative et rend compte des écrits scientifiques sur la symptomatologie similaire entre les troubles psychotiques et dissociatifs, sur leur étiologie traumatique et sur les études sur la dissociation et la schizophrénie. Le deuxième article est quant à lui un article empirique rendant compte de la méthodologie utilisée pour répondre à la question de recherche. En effet, aucune étude jusqu’ici n’a testé systématiquement les critères de la schizophrénie dissociative. Nos résultats démontrent que 24% de notre échantillon (N=50) pourrait recevoir le diagnostic de schizophrénie dissociative avec les critères proposés par Ross (2004). Toutefois, ces critères posant problème, une modification a été proposée et une prévalence de 14% a alors été trouvée. Des vignettes cliniques sont présentées afin de comparer nos participants avec ceux rapportés ailleurs. Les liens entre symptômes psychotiques et dissociatifs sont discutés en essayant de conceptualiser la schizophrénie dissociative de différentes manières, soit comme une nouvelle entité clinique, comme un trouble comorbide ou dans un contexte nosographique psychodynamique. / The existence of a dissociative subtype of schizophrenia has been suggested by several authors to account for the symptomatology of a group of people whose primary diagnosis is in the schizophrenia spectrum but have in addition dissociative symptoms (Ross, 2004; Sar et al, 2010; Van der Hart, Witztum, & Friedman, 1993). Of traumatic origin, this type of clinical picture where psychotic and dissociative symptoms are intertwined was first described more than a century ago (Janet & Raymond, 1898) but disappeared in the 30’s, having been incorporated to the concept of "schizophrenia" (Rosenbaum, 1980). It is in a new nosographic context that the concept of dissociative schizophrenia resurfaced. Indeed, psychiatric nosography took a turn in 1980 when the approach advocated by the DSM became descriptive rather than based on psychoanalytic conceptualizations. The psychiatric conditions of the time were divided into disorders whose symptoms tended to occur together (Cooper, 2004). Consequently, the presence of comorbid disorders increased. Given the frequently reported co-occurrence of psychotic and dissociative disorders, the phenomenological similarity of their symptoms and their potential traumatic etiology, Ross (2004) proposed a criteria set for the diagnosis of dissociative schizophrenia. The main objective of this thesis is to determine whether the dissociative schizophrenia, as defined by Ross (2004), exists. The first article focuses on the problem and the theoretical background that led to the research question. It aims at providing an overview of the issues surrounding the question of dissociative schizophrenia. It also reports on the literature pertaining to symptoms found in both psychotic and dissociative disorders, their traumatic etiology and studies on dissociation and schizophrenia. The second article is of empirical nature and reports the methodology used to answer the research question. Indeed, no study to date has systematically tested the criteria for dissociative schizophrenia. Our results show that 24 % of our sample (N = 50) could receive a diagnosis of schizophrenia with dissociative criteria proposed by Ross (2004). However, the criteria set was problematic so a modification was proposed and a prevalence of 14% was then found. Clinical vignettes are presented to compare our participants with those reported elsewhere. The links between psychotic and dissociative symptoms are discussed in trying to conceptualize dissociative schizophrenia in different ways, either as a new clinical entity, as a comorbid disorder or in a psychodynamic nosographic context.

Made available in DSpace on 2016-06-02T20:12:10Z (GMT). No. of bitstreams: 1 TeseJRBM.pdf: 1767918 bytes, checksum: 200ee529156f1dbfe98eeab387ba9dc6 (MD5) Previous issue date: 2006-12-15 / This doctoral thesis intends to analyze the main concepts of mental disease and the problematic relation between the organicism and the psychodinamism throughout the history of the psychopathologic ideas that came to constitute the scientific clinical psychiatry, from Philippe Pinel, in the beginning of XIX century, until the chaos of the no theoretical pretense descriptive of the official nosography of the end of XX century and beginning of XXI century (I.C.D.-10). The epistemologic conflict between the psychogenic and organogenic doctrines had resulted in many frustrated attempts of solution. The hermeneuticsynthetic psychopathology of Carl Gustav the Jung (1875-1961) and the phenomenonstructural psychopathology of Eugène Minkowski (1885-1972) stand out among the most promising proposals of XX century. The basic concepts of these authors keep an essential similarity, besides belonging to schools have different thoughts. However, their theorization go in parallel thinking about a psychopathologic formularization psychorganodinamic that is similar in its most essential principles. The antimechanist solution, anti-atomicist and antireductionist, of both, remind the current biological psychiatry that the desired and necessary consensual psychiatric theory will not do without a Metapsychopatology of the psychiatry that consider the irreducible biopsychosocial complexity of the normal or pathological human being. And, neither psychiatry will gain a satisfactory nosographic formularization while they don t reveal the mysteries of the complex etiology of mental disorders. / A presente tese de doutorado pretende analisar os principais conceitos de doença mental e a problemática relação entre o organicismo e o psicodinamismo ao longo da história das idéias psicopatológicas que vieram constituir a psiquiatria clínica científica, a partir de Philippe Pinel, no início do século XIX, até o caos da pretensa ateoricidade descritiva da nosografia oficial do final do século XX e início do século XXI (C.I.D.-10). O conflito epistemológico entre as doutrinas psicogênicas e organogênicas resultou em várias tentativas frustradas de solução. Dentre as mais promissoras propostas do século XX, destacam-se as da psicopatologia hermenêutico-sintética de Carl Gustav Jung (1875-1961) e da psicopatologia fenomeno-estrutural de Eugène Minkowski (1885-1972). Os conceitos fundamentais desses autores guardam uma semelhança essencial, apesar de pertencerem a escolas de pensamento diferentes; todavia, suas teorizações caminham paralelamente no sentido de uma formulação psicopatológica psicorganodinâmica muito parecida em seus princípios mais essenciais. A solução antimecanicista, anti-atomicista e anti-reducionista, de ambos, lembram à psiquiatria biológica atual que a tão desejada e necessária teoria psiquiátrica consensual não prescindirá de uma Metapsicopatologia da psiquiatria que considere a complexidade biopsicossocial irredutível do ser humano normal ou patológico. E, tampouco a psiquiatria chegará a uma formulação nosográfica satisfatória enquanto não desvendar os mistérios da etiologia complexa dos transtornos mentais.