Contemporary Psychiatry Research Articles

From epileptic hysteria to psychogenic non epileptic seizure: Continuity or discontinuity for contemporary psychiatry?

In the wake of Charcot, the École de la Salpêtrière became passionate about major crises or hysterical attacks: at the time, hysteria was not just about this great crisis, even if it represented an ideal heuristic model for a patient presentation that left a lasting impression on people's minds. The great attack is a framework for the study of hystero-epilepsy that opens the way to psychopathological explanation. The heirs of the Salpêtrière School's knowledge protesters each boast of imposing a universal model of hysteria seen from the perspective of its causes. If Babinski considers hysteria to be a purely psychogenic mechanism, it is of the subconscious mind or self-suggestion, the subject abandoning himself to his symptom. Unlike pithiatism, Freud and Breuer understand crisis as the cleavage of the content of consciousness that testifies to the return of a forgotten traumatic memory. These questions, partly eclipsed by modern psychiatry, are resurfacing with the description of a new clinical entity: the nonepileptic psychogenic seizure.Non-epileptic psychogenic seizures (PNES) can be defined as paroxysmal manifestations clinically suggestive of epileptic seizures but related to unconscious psychogenic processes. Clinical diagnosis is particularly difficult. Most patients with PNES incorrectly use anticonvulsant therapy, which is ineffective and has frequent side effects. To establish a diagnosis that discriminates between PNES and epilepsy, the electroencephalographic recording coupled with a video recording is the paraclinical examination of choice. The treatment of PNESs is complex: despite a diagnosis made by the patient and joint follow-up by a specialized team of neurologists and psychiatrists, the prognosis remains uncertain.We sought a phenomenal continuity between a major hysterical attack, hystero-epilepsy and a non-epileptic psychogenic seizure. From one time to another, the diagnosis of epileptic seizures is a diagnosis of clinical and paraclinical elimination. A reference to hysteria is found over time, currently confusing into dissociative and somatoform disorders. Consistent with ancient theories, the psychotraumatic dimension of the epileptoid phenomenon is found in recent epidemiological studies.Since hysteria was not just about major attacks, the entity called PNES is a group of clinical manifestations with heterogeneous etiologies. Some research teams consider PNESs to be the result of non-epileptic, normal electroencephalogram neuronal hyperexcitability. Other authors have adopted the etiological hypothesis of recurrent dissociative disorders and equivalent to a particular form of post-traumatic stress disorder.

A half-century of participant observation in psychiatry. Part III: psychopharmacology.

The third part of the triptych of my 50-year activity in psychiatry is about psychopharmacology. This way of treatment changed the picture of contemporary psychiatry. The introduction of neuroleptic (antipsychotic) drugs and tricyclic antidepressants in the 1950s resulted in a therapeutic revolution and contributed to the ‛medicalization' of psychiatry and its therapeutic similarity to other non-surgical specialties. Adiscovery of prophylactic lithium activity in the1960s initiated the mood-stabilizing drugs.During the last half-century, the most dynamic was the 1990s when most antipsychotic and antidepressant drugs of the so-called new generation were introduced. The twenty-first century marks a debut of next antidepressant and antipsychotic drugs, some of the latter having long-acting injectable preparations. An interesting event was a demonstration of the antidepressant activity of ketamine. My research domain in psychopharmacology was lithium treatment of affective illnesses. Lithium makes the topic of many papers I authored, more than 150 of them are in the PubMed database. Many clinical and research aspects related to lithium administration have been reported as first in Polish literature and some are pioneering in the world. Recently, I wrote the book Lithium - the amazing drug in psychiatry which has also its English version. I have carried much research on antidepressant drugs, pharmacotherapy of treatment-resistant depression, and mood-stabilizing drugs for which I proposed a modern classification. I participated in European projects EUFEST and OPTIMISE on the optimization of using antipsychotic drugs in schizophrenia. I also performed much research on the antidepressant effect of ketamine and electroconvulsive therapy.

The role of Community Mental Health in a new architecture of World psychiatry and Global Mental Health

Introduction. The influx of new knowledge and scientific contributions into contemporary world psychiatry has counted on a vigorous dissemination through technology-inspired means. This process has led to the realities of Global Mental Health (GMH) inspired by “a new epistemology” of mostly positivistic roots. Objective. To explore the basis of these realities and the resulting homogenization attempts of psychiatry as a medical, clinical, and research discipline. Discussion and conclusion. The need for “a new architecture” of contemporary psychiatry is discussed as a reflection of a correct epistemological exercise and a renewed pact between professionals and communities, materialized in and enriched by the re-emerging Community Mental Health (CMH) movement. The essential bases of the movement are presented, and its mutually collaborative, multidisciplinary, integrated, and realistic nature, as reflected in national efforts like Peru’s in Latin America, is described.

Évolution et actualité des considérations sur le rapport rêve–psychose en psychanalyse

AimThis article reviews the evolution of historical and current discussions, as well as the etiological relationships between dreams and psychoses, within psychoanalytic clinical work and within classical and contemporary psychiatry. MethodsThe dreams-psychoses relationship is studied through a critique of the DSM-IV perspective (nightmares, night terrors, and sleep-walking) and through contemporary psychoanalytic theses. In this article, the reader will also find two case studies: a case of schizophrenia in which the use of dreams stabilized the delirious metaphor, and a second one showing veritable analytical work on dreams in a case of paranoia. ResultsAccording to the psychoanalytic paradigm and by stating differences between analytical and clinical work, with C.S. Peirce's notion of index, dreams can become a key tool for the treatment of psychoses. DiscussionWithin the dreams-psychoses relationship, there is a distinction to be made between index-dreams and signifier-dreams. Dreams in psychoses can become an index of an encounter of the subject with the Real. ConclusionThe connection of dreamlike phenomena with those of psychoses highlights that the work of dreams is not reserved only for neuroses. In this case, the clinician can expect much more than a simple classification, testimony, or observation of surprising facts. Dreams can thus provide material for analytical work capable of participating in the production of a lasting change of the patient's subjective position.

The role of psychopathology and nosology in 'precision' psychiatry

Psychopathology is the scientific exploration of abnormal mental experiences and behaviour that, for more than a century, has provided a Gestalt for psychiatric disorders and, thereby, the basis of psychiatric nosology. Having guided clinical and scientific progress in modern psychiatry, in consequence of considerable technical progress, psychopathology has been increasingly marginalised by neurobiological research. Albeit the precise, careful and qualified assessment of psychopathology has been a core skill of mental health professionals, today's curricula pay increasingly less attention to its training. However, because neurobiological models still have to prove their diagnostic superiority and despite all prophecies that psychopathology was doomed, psychiatric diagnoses in both DSM-5 and ICD-11 continue to rely exclusively on psychopathology. Their categorical nosology is also challenged by advances in computational psychiatry and an increasingly advocated personalised symptom-based approach to precision psychiatry. The current paper reviews the objectives of psychopathology and nosology, and the recent debate on their role in future precision psychiatry - from guiding neurobiological research by relating neurobiological changes to patients' experiences to giving a framework to the psychiatric encounter. It concludes that contemporary psychiatry does not need less but rather a more differentiated psychopathology and a likely reformed, possibly more dimensional nosology in order to develop approaches that adequately integrate patients' experiences and professional knowledge.

Model biomedyczny w psychopatologii. Krytyczny szkic historyczny, współczesny kontekst i problemy etyczne

Artykuł prezentuje krytyczny szkic historyczny i charakterystykę biomedycznego modelu psychopatologii, koncentrując się na drugiej połowie XX w. Wskazuje i opisuje także kluczowe problemy związane z jego dominacją we współczesnej praktyce klinicznej i badawczej. Problemy te dotyczą, m. in., trafności i rzetelności diagnoz psychiatrycznych, metodologii badań, skuteczności leczenia, czy też wpływów koncernów farmaceutycznych na działalność naukową i terapeutyczną. Poważne konceptualne problemy całego modelu stawiają pod znakiem zapytania fundamenty współczesnej psychiatrii oraz opartą na nich wiedzę. Nie udało się stworzyć przekonujących biologicznych wyjaśnień zaburzeń psychicznych ani zidentyfikować mechanizmów odpowiadających za ich powstawanie. Uzasadnione wątpliwości istnieją także w odniesieniu do najczęściej przepisywanych współcześnie leków: przeciwpsychotycznych i antydepresyjnych – pomimo ich coraz szerszego stosowania, przybywa ludzi przewlekle chorych. Rodzi to poważne dylematy etyczne i uzasadnione pytania o nadmierną medykalizację kwestii wiązanych ze zdrowiem psychicznym. Konieczna wydaje się reforma dominującego modelu i wzrost nakładów na badania i praktykę uwzględniającą czynniki psychologiczne, społeczne i kulturowe.

T192. BINSWANGER’S THREE FORMS OF FAILED EXISTENCE AND ITS RELEVANCE FOR CONTEMPORARY PSYCHIATRY

BackgroundSocial impairment is a hallmark feature of schizophrenia spectrum disorders and the subject of much research attention. In contemporary psychiatry the principal way of understanding and examining these difficulties is closely linked to the concept of social cognition, but while this approach has yielded valuable results it has still left the bulk of the variance of social functioning unaccounted for. By zooming out from subpersonal constructs and engaging with first hand experiences of lived through sociality, the phenomenological tradition offers a complementary viewpoint. One prominent proponent hereof is Ludwig Binswanger, but unfortunately much of his pivotal work is only accessible in the original German. It is the purpose of this presentation to introduce some of his central but largely overlooked insights to a wider audience and to highlight their relevance for current research and clinical practice.MethodsA reading of Binswanger’s magnum opus Drei Formen missglückten Daseins of which only a fraction has previously been presented to an Anglophone readership.ResultsTo Binswanger, schizophrenic existence is, at its very core, marked by a breakdown of natural experience understood as the unreflective and unobtrusive processes which usually afford us a sense of harmony with ourselves, others, and the material world. In its place schizophrenic autism may transpire and be traced in three forms of existential failure: extravagance (“Verstiegenheit”), perverseness (“Verschrobenheit”), and manneristic behavior (“Maniertheit”). These are not mere defects or plain symptoms, but represent modified modes of being in the world, which all testify to a breakdown of the intersubjective dimension. In extravagance a certain disproportion between basic features of human existence eschews the existential “order of preference”, which usually affords us a basic trust in being, a tacit feeling of ontological security, and the possibility of true community with others. Perverseness, then, denotes a replacement of pragmatic prudence and seamless adjustment to the world and others with withdrawal, resistance, and certain private concepts, principles or rules. Finally, manneristic behavior, deeply rooted in a loss of basic trust, represents an inauthentic mode of being in which the self may be defeated in an effort to appropriate some foreign model of existence.DiscussionFrom Binswanger’s descriptions of these modified modes of existence three key insights emerge, which all challenge fundamental, if often tacitly held, assumptions in current psychiatric research and clinical practice: 1) Intersubjective difficulties are not simple symptoms or add-ons that may or may not be present, but constitutive features of the schizophrenic Gestalt. 2) Intersubjective difficulties in schizophrenia spectrum disorders cannot be reduced to the dysfunction of one or more modular psychological constructs or to mere sequelae of specific symptoms and signs. Rather, they reflect a fundamentally and globally altered structure of subjectivity. 3) Schizophrenic autism and intersubjective difficulties cannot be sufficiently understood in purely behavioral terms as a tendency to withdraw or isolate oneself or as an insufficient stock of knowledge. Autism is neither a neatly demarcated symptom or sign nor a simple defect but transpires through the various clinical manifestations. It is perhaps best understood as a disruption of the basic prereflective attunement with the shared-social world.If taken seriously, these realizations might be helpful in developing novel and complementary ways of understanding and engaging with schizophrenia spectrum patients’ oftentimes altered existential styles.

'The schizophrenic basic mood (self-disorder)', by Hans W Gruhle (1929).

During the first half of the twentieth century, German psychiatry came to consider 'Ich-Störungen', best translated as self-disorders, to be important features of schizophrenia. The present text is a translation of a chapter by the German psychiatrist Hans Gruhle, which is extraordinarily clear and emblematic for this research line. Published in 1929, it was part of a book co-written with Josef Berze, The Psychology of Schizophrenia (concerning its subjectivity). Gruhle claims that the essential core of schizophrenia is of an affective nature, a 'mood' manifesting itself as self-disorder, an unstable, incomplete pre-reflective self-awareness. His impact on contemporary psychiatry was probably limited due to his confrontational style, but this text has great significance for the modern revival of phenomenological research in schizophrenia.

Arthur Schopenhauer and psychiatry 200 years after the publication of The World as Will and Representation (Idea)

In 2018 the academy will celebrate the 200th anniversary of the publication of the seminal work of Arthur Schopenhauer (1788–1860): The World as Will and Representation (Idea). Schopenhauer is known as the “philosopher of pessimism” and as the “psychologist of the will”. His thinking is formally absent in the psychiatric education curricula, which could be enriched by the philosopher's work. Regarding psychiatry's theoretical foundations, Schopenhauer: a) anticipated several issues of species’ origin and evolution, which are used in the contemporary understanding of disease development; b) anticipated some attributes of the psychodynamic and cognitive unconscious when referring to the irrational features of the will; c) foresaw the current concept of the embodied mind, which emphasizes the role of the body's structure and dynamics in cognition instead of that of a transcendental reason; d) proposed a simplified and heuristic model of mind, comprising the senses, understanding and reason; at a pragmatic level, particularly concerning psychotherapy, the philosopher e) stated that all human actions spring from three fundamental sources: egoism, malice and compassion; he also speculated about the role of unconscious repression in the genesis of mental illnesses; and finally, f) emphasized the ubiquity of suffering and the insatiability of desire, which unavoidably leads to egocentrism. In this regard he highly valued contemplation of art and nature as a way of dissociating knowledge from desire, and thus allowing the development of compassion and asceticism. This was considered by the philosopher to be “denial of the will”, and a path for individual salvation and well-being. In contemporary psychiatry, this metaphysical proposal may be reformulated in terms of promoting cooperation and healthy austerity as a non-specific component of most psychotherapies and educational models. Schopenhauer's thinking may enrich psychiatric training and personal well-being.

Lithium treatment in the era of personalized medicine

In 1949, an Australian psychiatrist, John Cade, reported on the antimanic efficacy of lithium carbonate, which is regarded as an introduction of lithium into contemporary psychiatry. Since the 1960s, lithium has been a precursor of mood stabilizers and has become first-choice drug for the prevention of affective episodes in mood disorders. For nearly four decades, lithium has also been used for the augmentation of antidepressant drugs in treatment-resistant depression. The knowledge of clinical and biological factors connected with the capability of long-term lithium treatment to prevent manic and depressive recurrences makes an important element of the personalized medicine of mood disorders. Excellent prophylactic lithium responders can be characterized by distinct mood episodes, with full remissions between them, the absence of other psychiatric morbidity, and the family history of bipolar illness. In recent years, many other clinical and biological factors connected with such a response have been identified, helping to select the best candidates for lithium prophylaxis. The antisuicidal effect of lithium during its long-term administration has been demonstrated and should also be taken into account as the element of personalized medicine for the pharmacological prophylaxis of patients with mood disorders. Several studies pertaining to personalized medicine were also dedicated to lithium treatment of acute mood episodes. Lithium still has a value in the treatment of mania and bipolar depression. However, it seems that the more important indication would be the augmentation of antidepressant drugs in treatment-resistant depression. The factors connected with the efficacy of lithium in these conditions are reviewed.

PRIMARY EPISODE OF BIPOLAR AFFECTIVE DISORDER

Background. Bipolar affective disorder (BAD) is a topical issue of contemporary psychiatry. The features of the primary episode (PE) of the disease are extremely important for prognosis, treatment and rehabilitation measures of BAD. Individual psychological features of the patients with PE of BAD are still unexplored that complicates development of new methods of prediction, treatment and prevention of BAD. Objective. The aim of the study was to investigate individual psychological features of the patients with a primary episode of bipolar affective disorder, taking into account the gender factor and clinical variant of the BAD debut. Methods. 153 patients (65 men and 88 women) with a primary episode of bipolar affective disorder were examined. The patients were divided into three groups according to the clinical variant of the course of PE of BAD: depressive variant, manic variant and mixed variant. The examination was carried out using the Standardized multifactor method of personality research (SMMPR). Statistical processing of the data was performed using the non-parametric Mann-Whitney test. Results. The most significant differences in the quantitative indicators of SMMPR were found when comparing depressive and manic, as well as depressive and mixed variants of PE of BAD, and lesser – when comparing manic and mixed variants. Most of all, these differences were expressed in terms of pessimism, impulsiveness, individualism and optimism. Conclusions. Some peculiar features of male and female patients with depressive, manic and mixed variants of PE of BAD promoting to search for new methods of prediction, treatment and prevention of BAD have been defined.

Le développement de paradigmes psycholinguistiques devient nécessaire à l’espace de la psychotraumatologie. Analyse critique de la littérature anglophone et des premiers travaux francophones. Vers un nouveau modèle du traumatisme psychique

Resume Objectifs Si l’interet pour la psychotraumatologie s’est progressivement generalise au cours de la derniere decennie, faute de reperage diagnostique, de nombreux patients restent sans soins tandis que parallelement, l’offre de psychotherapies differenciees s’est majoree. Notons egalement que si les recherches en neurosciences ont explose en nombre, leurs applications concretes utiles a la pratique quotidienne semblent plus tenues, notamment au plan pharmacologique. De tels achoppements seraient-ils causes par une preeminence de la reference au « stress » au detriment de la consideration du « trauma » ? Au-dela des picrocholines querelles d’ecoles, il apparait aujourd’hui necessaire de construire une nouvelle phase d’analyse. Methodes Nous exposons une revue critique de la litterature de langue anglaise avant de focaliser sur les quelques etudes francophones existantes. Resultats La majorite des etudes anglophones referencees se rattachent aux protocoles de deux travaux princeps sans que les paradigmes linguistiques en soutenant le design apparaissent tres structures. L’analyse linguistique s’y avere en fait limitee, sans mention des richesses apportees par les ecoles de semantique et de pragmatique. Il apparait toutefois une lente complexification des methodes d’analyse textuelle dans le temps. Pour l’espace francophone, seules deux etudes existent : l’une de Louis Crocq datant des annees 1960, et une autre de Ribeton & Auxemery mettant en evidence le syndrome psycholinguistique post-traumatique (anomie traumatique, repetitions linguistiques et desorganisation discursive). Conclusion Les troubles psychiques post-traumatiques beneficient d’un renouveau d’interet pour la psychiatrie et la psychologie contemporaines. La densification de la description du trouble de stress post-traumatique dans le DSM-5 pourrait encore se completer des differentes formes cliniques specifiques constituant les troubles psychiques post-traumatiques. Aussi, a l’heure ou differents protocoles psychotherapeutiques apparaissent concurrents (protocoles comportementaux et cognitifs, traitements par l’hypnose, therapies par mouvements oculaires, therapies psychodynamiques, therapies narratives, etc.), l’analyse de la restauration du langage pourrait permettre d’unifier une conception specifique du traumatisme psychique et de ses consequences cliniques. Le paradigme que nous proposons developpe la recherche clinique a l’aide de marqueurs psycholinguistiques offrant d’evaluer l’efficacite des psychotherapies.

Validity of the biopsychosocial model in contemporary psychiatry

The biopsychosocial model (BPSM) has been the foundation of psychiatric practice since it was first conceived four decades ago. However, recent advances in technology have led mental health professionals, as a fraternity, to turn to a purely biomedical model of disease, and remedy. We trace the lineage of the BPSM, examine its validity in today's scenario, and argue for the urgent need to reintegrate this model in current and future practice.

The Unbearable Lightness of Reductionist Physicalism in Contemporary Psychiatry

Being one of the most renowned subjects in philosophy, mind-body problem focuses on the relationship between physical and mental phenomena. Various approaches have been developed throughout history with two perspectives having been the most prominent: the claim that mind is of material nature (physicalism) and that mind is radically separate from physical existence (dualism). With its core premises, mind-body problem and different approaches to it are crucially relevant for psychiatry. Psychiatry, in its daily practice and theory, is situated right at the site of this so-called mind-body gap. Psychiatrists’ conceptualization of mind-body problem is deeply related not only to their views on the nature of subjectivity and free will; but also to their implicit and explicit assumptions about psychopathology. In this mind-body problem framework, physicality is mostly attributed to the nervous system, more specifically to the brain. Advances in genetics, molecular biology, cognitive science, psychopharmacology and brain imaging techniques have led neuroscientific paradigm to be the de facto conceptual framework for understanding mental activity and psychic experience. In this view, as with the rest of all psychological phenomena, mental disorders are also brain disorders and physical (i.e. reductionist) methods are key to understand, prevent, and treat these conditions. With the advent of neuroscience, biological approaches to psychopathology have also paved the way for the birth of a popular neuro-culture that shadow other approaches to psychopathology. Explaining complex phenomena through neurobiological substrates has paralleled the acceptance of a popular motto that can be summarized as “you are your brain”. Despite all expectations, diverted resources, and intellectual interest, neurobiological reductionism has yet to bring about the anticipated breakthrough in clinical practice of psychiatry. In this article, we aim to provide a brief overview of the mindbody problem, describe various aspects of neurobiological reductionism, and address its theoretical impasses and implications for psychiatry.

A Primer on Integral Theory and Its Application to Mental Health Care

Contemporary psychiatry has become increasingly focused on biological treatments. Many critics claim that the current paradigm of psychiatry has failed to address the escalating mental health-care needs of our communities and may even be contributing to psychopathology and the burden of mental illness. This article describes the foundations of Integral Theory and proposes that this model offers a framework for developing integral psychiatry and a more effective and compassionate mental health-care system. An integral model of psychiatry extends biopsychosocial approaches and provides the scaffolding for more effective approaches to integrative mental health care. Furthermore, rather than focusing on psychopathology, the Integral theory model describes the emergence of human consciousness and supports a mental health-care system that addresses mental illness but also promotes human flourishing.

« La transformation, c’est l’inopiné de l’objet ». Une rencontre avec Vassilis Kapsambelis

ObjectiveThis interview seeks to reflect on the current challenges of training clinicians in a context marked by significant changes in the field of psychiatry. Vassilis Kapsambelis, who has been a teacher for many years (as a theoretician, a clinician, and as an editor) and who has a dual status of psychiatrist and psychoanalyst, gives a lively and authentic accounting of his experience. MethodIn an open conversation with three interlocutors, Vassilis Kapsambelis is asked about his own career, which began in Greece in the late 1970s and continued in France. The analysis of the social and political context of psychiatry over the last forty years is largely evoked. ResultsThis story evokes the personal encounters (colleagues, teachers, and patients) that made a difference, as well as the inspiration of political commitment. Several pivotal periods in the history of contemporary psychiatry are discussed: the reform of psychiatry in the immediate aftermath of the war, the separation of neurology and psychiatry in 1968, the reform of the specialty internship in 1984. DiscussionThe history of psychiatry shows that its course is far from linear. Certain periods can be described as exceptional as they produce profound upheavals of the discipline. This was the case in the years following the Second World War, but this is no longer the case today. It is a “normal” period in the sense that it produces little innovation in clinical work. It is necessary to be able to be inspired by it without living in a sterile nostalgia. ConclusionsEach formation is singular and any subjective transformation is due to the unexpected nature of the object. Clinical training alone cannot engender the commitment and interest that often exist in the would-be clinician, and that can be informed by her or his personal psychoanalysis.

Towards Modern Depressive Disorder: Professional Understanding of Depression in Interwar Britain.

This article examines the way in which British psychiatrists defined, categorized, and applied depression in the period between the two World Wars. To analyze the professional understanding and application of the notion, various expert literatures will be analyzed, such as textbooks, medical journals, and medical documents kept in daily practice. Through the analysis, this article suggests that in the interwar decades, the status of depression as a distinct mental disorder was far from established in terms of its definition, terminology, and classification, although the disorder had already become the most prevalent mental illness by the turn of the century. Also, this article argues that the early twentieth century should be recognized as a part of the long evolution through which depression achieves its modernity, beginning in the early twentieth century and ending in the post-war era. Such findings about a specific psychiatric diagnosis can be applied to the explanation of contemporary psychiatry. At least before the Second World War, British psychiatry had not yet entered into its modern phase and was still under the strong influence of the Victorian medical tradition. Thus, this article claims that in order to understand British psychiatry and its characteristics against this historical background, continuity should be stressed rather than modernity.

Whatever Happened to Couples and Family Therapy in Psychiatry?

Whatever Happened to Couples and Family Therapy in Psychiatry?

Biopsychosocial Model in Contemporary Psychiatry: Current Validity and Future Prospects.

Biopsychosocial Model in Contemporary Psychiatry: Current Validity and Future Prospects.

Psychic wholeness in the context of Anna Terruwe and Conrad Baars’ theory of repressive neuroses

In the 1970s, two Dutch psychiatrists, Anna Terruwe and Conrad Baars, developed an innovative theory and therapy of repressive neuroses. Their theory was founded on the philosophical anthropology of Saint Thomas Aquinas. This approach to neuroses stemmed from the observation that contemporary psychiatry and psychology lacked philosophical underpinnings and that sciences thus formed were unable to help people. The key concept in the theory of repressive neuroses is psychic wholeness—the unity of the senses, the intellect, and will under the natural guidance of the last two of these. Stressing the great importance of this wholeness of human sensory and intellectual faculties for mental health has its consequences in the approach to and treatment of repressive neuroses. Every neurotic disorder is a kind of disintegration (repression of emotions and lack of intellectual control); therefore, the therapeutic process is supposed to effect a reintegration of distinct human faculties. The article presents the concept of psychic wholeness in the context of the theory of repressive neuroses, with special focus on Aquinas’ anthropology as the philosophical basis for this theory. Bowen’s concept of differentiation of self is also discussed and its similarities to psychic wholeness are pointed out.