Shifts in the philosophical foundations of psychiatry since Jaspers: implications for psychopathology and psychotherapy.

Jaspers' AllgemeinePsychopathologie, the General Psychopathology, published in 1923, had a profound influence on the development of psychiatry. Central to it was the attempt to give the new psychiatry a philosophical foundation, the key element in which was the dichotomy between meaningful and causal connections. This dichotomy was superimposed on the earlier mind-body distinction, and both converged on the conclusion that mind and meaning were problematic from the point of view of science. The inevitable splits came to a head in the 1960's, with attacks on the one side by the other: medical psychiatry was attacked for systematically stripping madness of its meaning and hence dehumanising it, while psychoanalysis, the champion of meaning, was rounded upon for being unscientific. At the same time however there was emerging a new paradigm that effectively deconstructed the problematic, namely, the cognitive or information-processing paradigm. This paradigm has made it possible to construct a unified bio-psycho-social science of psychopathology. In psychotherapy, the shift has been away from the view that meaning is non-causal, a matter only of existential significance or of hermeneutic interpretation, towards the working assumption that it is crucially involved in aetiology, as in the new cognitive behaviour therapy paradigm.