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Series Editor Foreword

Psychiatry Innovated: How History Matters

The centrally important finding of this book is diagnostic—Germán Berrios and his
students have benefitted from the lifetime of chronic bibliofilia of the founder of the
Cambridge School of Psychiatry. This deep love for books—old and new—has
made it possible for Berrios to create a deeply international tradition within psy-
chiatry that values interdisciplinary work between psychopathology, history, and
psychology. The Cambridge School of Psychiatry that has been established by his
diligent work on the border zone of history of psychiatry and theoretical innovations
in our understanding of psychopathology has much to offer psychology.
Berrios’ tradition has proliferated all over the world where many like-minded
specialists—represented in this book—have in different intricate ways resisted the
takeover of the human mind by waves of social and historical myopic fashions. In
psychiatry—as well as in popular presentations of its subject matter in the media—
varieties of naïve efforts to reduce the complexity of the mind to brain structures on
either end of the corpus callosum have proliferated. This is the nature of the com-
mon sense mentality—it tries to reduce the mind to its simple parts. Berrios and the
contributors to this book understand that any kind of intellectual reductionism—be
that of neuroscientific or socio-ideological beliefs in “artificial intelligence” or “big
data”—is doomed to failure. His deep knowledge of history of psychiatry has kept
his mind delightfully perceptive of the naivete of any reductionism. Writing on the
history of hallucinations, he commented how in the nineteenth century
… hallucinations became ‘natural kinds’– i.e., ‘objects of nature’ such as dogs, gold, cells,
mitochondria, neurotransmitter molecules, patterns of electric firing or of blood flow in the
brain – rather than abstract entities such as meaning, belief, beauty, virtue, quality, interpre-
tation, and so on. This transformation affected the way in which certain human experiences
were socially interpreted, for example, mystical visions were no longer countenanced as
reflecting reality. In relation to the naturalization of hallucinations the role of the historian
is to explain how it came to pass (Berrios 2005, p. 231)

vii
viii Series Editor Foreword

It is precisely in the “science wars” of the nineteenth century where the theoretical
problems that haunt us in the twenty-first century were set up (Valsiner 2012). The
focus on complexity of phenomena that was maintained within the Naturphilosophie
of the first decades of the nineteenth century was replaced by the mechanistic intel-
lectual engine power of Naturwissenschaften. The result is an intellectual amnesia
of our contemporary looks at history of the human sciences that disconnects our
thinking from the first efforts of development of ideas in the second half of nine-
teenth century in psychology and psychiatry. These efforts remain buried on the
pages of many books published in that century—and it takes a history-oriented bib-
liophile like Berrios to bring these out to his students.
Why have sciences over the twentieth century become aversive to philosophies?
After all, our specific scientific ideas are the result of generalizing abstraction—
often done without self-reflexivity. This is different in the Cambridge School of
Psychiatry—here, the historical self-reflexivity of the discipline leads to the under-
standing of the human psyche. It focuses on the phenomenology of the human
mind—rather than on the manualized empirical accumulations of summary data.
How can human sciences become alienated from phenomenology? I would claim
that the culprit here is the ideology of empiricism—“science is empirical!” is the
slogan we hear over and over again. But can this be true? There are two ways to
answer that question. First, no science can be completely empirical (“data-driven”)
since any setup of an “empirical investigation” is embedded in a network of implicit
or explicit theoretical ideas. Hence, any science cannot be “empirical only”—or if
it pretends to be, it ends up being pseudo-empirical as Jan Smedslund has repeat-
edly pointed out about psychology (Smedslund 1991, 1995, 2016—in this book
series covered by Lindstad et al. 2020). The absence of theoretical self-reflexivity
does not make a science “empirical.” It makes it confused.
The second way to make sense of the “empirical” is to look into the history of the
meaning of that term. In the second half of the nineteenth century, it was used in the
meaning of experiential—based on experience. The experience involved was that of
the researcher or practitioner—rather than that of the person under investigation.
Franz Brentano’s Psychologie vom empirischen Standpunkte (Brentano 1874) that
was of key relevance for efforts to maintain focus on intentionality of the human
psyche used “empirical” in that sense. The primary experience of the Other is that
of the psychologist or psychiatrist or of natural or social scientist in general. This
makes German Berrios’ many small excursions into the history of psychiatry par-
ticularly valuable.1 He does not write about the experiences of the classic psychiat-
ric authors; in his many introductions to his translations of the original texts, he
writes with the authors. This allows him to penetrate into the emerging thinking of
the classic writers in psychiatry and psychology and to show how specific terms
now used routinely and unreflectively in psychology and psychiatry were results of

1
In his journal History of Psychiatry (Sage), he has the habit of publishing short key texts of origi-
nal authors of his translations, furnished with his introductory comments. These comments serve
the function of linking the original ideas of the past with our possible future advancements of the
field. History is in the service of the future.
Series Editor Foreword ix

painstaking efforts to generalize from common observations of the immediate expe-

rience. Again, science needs to transcend this empirical experience, while practice
needs to recontextualize the abstracted knowledge in the new real case—a patient,
an event, and, most importantly, the social encounter of the researcher and the
researchee and of the doctor and the patient.
The contributions to this book emphasize the point of the dialogical nature of
psychiatry—based on the reciprocity in the work of a psychiatrist with a patient.
This work leads to the establishment of cultural configurations that set up cultural
frames for biological or symbolic signals on a deep level, guiding the processes
involved in the formation of symptoms. This gives us a general model of emergence
of symptoms—the cultural configurators can weaken, distort, or annihilate the spec-
ificity of the biological signals and the information linked to the primary experi-
ence. This work of cultural configurations is accomplished by the direct process of
Person-Others (including the case of doctor-patient) relations, under the guidance
of the set of social representations inherent in the socialized human minds. The link-
ages of the new psychiatry of the Cambridge School with the new traditions of
cultural psychology—those of Social Representation Theory of Serge Moscovici
(2001) and the Dialogical Self Theory of Hubert Hermans (2018)—become visible
in this volume. The interdisciplinary effort toward synthesis of psychiatry with
other human sciences is one of the credos of the Cambridge School of Psychiatry.
Reading through this volume, I discover remarkable similarities between the his-
tories of psychiatry and psychology over the last two centuries. Both started from
the phenomena of deeply subjective kind (the “soul”—Seele—in its many manifes-
tations) and went through a similar defense of their independence from the mecha-
nistic natural sciences over the nineteenth century: it was a struggle which both lost.
The soul was lost or became hidden under scientific-looking terms like mind and
self. Poets—but not psychiatrists or psychologists—could operate further with the
soul, science, no more.
Now—another hundred years later—we can see the rebirth of the original focus
on in-depth phenomena in both psychology and psychiatry, yet maintaining the sub-
dominant role in respect to the “evidence-based” medicine and science. The phe-
nomena in psychopathology are of poorly definable boundaries—relying on the
introspective revelations by the persons. This is an extension from the ordinary
higher-level phenomena of the human psyche in psychology where the phenomena
might be describable only in vague terms, but they have very concrete implications
for the person’s conduct (Janet 1921). The person—in one’s ordinary roles or in that
of a psychiatric patient—lives within one’s own meaningful world. It is a world
characterized by totality of the field. The new direction in psychiatry that the
Cambridge School brings to psychiatry builds on the same general efforts that
Ganzheitspsychologie tried—and failed—hundred years ago (Diriwächter 2008).
Instead of figuring out how the vague abstract fields—like justice, honesty, corrup-
tion, fidelity, etc.—operate in human lives, science demanded the forgetting of the
whole and counting its parts as if these told us the full story. They never did.
It is perhaps time for both psychiatry and psychology to try again—based on the
axiom that precision in the case of mental phenomena is in their vagueness of
x Series Editor Foreword

p­ resentation by signs. This has profound implications for our research practices—
instead of “measurement” of the mental symptoms as objects (something that is),
the focus would need to be on the potential for emergence. The borders of psycho-
pathology are being tested constantly in our ordinary minds that comes close—but
need not usually surpass—the vague border of “norm” and “pathology.” Where does
the ordinary imagery of one’s parents’ voices in everyday life (“I hear my mother
saying be careful!”) transcend to the state where these voices become felt as if over-
whelmingly “controlling,” “surveying,” or “torturing” the person. The latter case is
that of crossing the border on the normal road from ordinary to pathological state of
mind—a novelty added on to the previous normal state (Marková and Berrios 2011).
Psychopathology can be a domain of growth—albeit in a discomforting direction—
rather than a loss of previously normal function. As such, these growth moments are
parts of the general personal life course where different individual life trajectories
can converge upon similar general state. Chen’s example (Chapter 8 in this volume)
illustrates the equifinality in the emergence of symptoms:
In a real-life clinical example, a civil servant who had for a few years been under investiga-
tion for corruption was notified that the investigation concluded with no charges against
him. Nevertheless, for many years afterwards, he continued to feel under surveillance and
being followed on the streets. The perception of surveillance took place in a context of past
events (i.e. a diachronic context). This situation is expected to carry very different weight
from another person who feels that he/she is being followed on the streets de novo without
the same background. Symptoms that occur directly in response to a stressor are more
likely to subside when the stressor is removed. A symptom that emerges without an explicit
external stressor would be expected to be less likely to subside with changes in the environ-
ment (p. 69, added underlining)

What follows from this example—and many other ideas expressed by the contribu-
tors to this book—is not the generic call “context is important!” but its developmen-
tal relevance (cf. Villagrán Moreno and Luque, Chapter 11). There are many ways
to the same (looking) symptom—a basic principle in any open systemic phenome-
non. Contexts—and the phenomena they are contexts for—emerge and transform in
time and in relation to macro-social meanings (e.g., “corruption,” “abuse,” etc.) that
constitute social valuation imperatives in the given society at the given time. The
development of such macro-social meanings is expected to be divergent from the
meaning construction of individual persons. I as a father of a by now adult daughter
might have had no idea that my gentle embracing her as she was a beautiful adoles-
cent could be by now—retrospectively—viewable as “abuse.” The reverse diver-
gence is also possible—a mother may be convinced that she has been hitting her
adolescent daughter and accusing herself—“I am an abuser and feel guilty of it”—
until it was found out that none of this actually happened (Museaus and Brinkmann
2011). Psychopathology becomes discovered in the latter, not the former. It is the
insight into one’s own feelings and thinking rather than responses to standardized
questionnaires that is the focus of clinical practice and—ideally—of research. The
distinction of awareness from insight (Marková and Berrios 2011) is crucial for both
psychiatry and psychology.
Series Editor Foreword xi

Last—but not least—it is the profoundly international nature of scholarship that

characterizes the Cambridge School of German Berrios, and that is visible all
through this book. The integration of perspectives from South America and Europe,
with their further extensions to the rest of the world, gives us a true example of how
scholars from very different backgrounds intellectually fertilize one another on the
path of searching for new solutions in a developing medical science as psychiatry is.
There is much for all of us to learn from the Peruvian-accented European thinking
that the love for books brings to our new science.

Aalborg, Denmark Jaan Valsiner

November 2019

References

Berrios, G. E. (2005). Introduction to “On the fantastic apparitions of vision” by Johannes Müller.
History of Psychiatry, 16(2), 229–246.
Brentano, F. (1874). Psychologie vom empirischen Standpunkte. Leipzig: Verlag von Duncker &
Humblot.
Diriwächter, R. (2008). Genetic Ganzheitspsychologie. In R. Diriwächter & J. Valsiner (Eds.),
Striving for the Whole (pp. 21–47). New Brunswick: Transaction.
Hermans, H. J. M. (2018). Society in the self. Oxford: Oxford University Press.
Janet, P. (1921). The fear of action. Journal of Abnormal Psychology and Social Psychology, 15(1),
150–160.
Lindstad, T., Stänicke, E., & Valsiner, J. (Eds.). (2020). Respect for thought. New York: Springer.
Marková, I. S., & Berrios, G. (2011). Awareness and insight in psychopathology: An essential
distinction? Theory & Psychology, 21(4), 421–437.
Moscovici, S. (2001). Social representations. New York: New York University Press.
Museeus, P., & Brinkmann, S. (2011). The semiosis of family conflict: A case of home-based
psychotherapy. Culture & Psychology, 17(1), 47–63.
Smedslund, J. (1991). The pseudoempirical in psychology and the case for Psychologic.
Psychological Inquiry, 2(4), 325–330.
Smedslund, J. (1995). Psychologic: Common sense and the pseudoempirical. In J. A. Smith,
R. Harre, & L. van Langenhoeve (Eds.), Rethinking psychology (pp. 196–206). London: Sage.
Smedslund, J. (2016). Why psychology cannot be an empirical science. IPBS: Integrative
Psychological & Behavioral Science, 50, 185–195.
Valsiner, J. (2012). A guided science: History of psychology in the mirror of its making. New
Brunswick: Transaction Publishers.
Valsiner, J. (Ed.). (2020). Social Philosophy of science for the social sciences. New York: Springer.
Contents

  1 Introduction����������������������������������������������������������������������������������������������    1
Ivana S. Marková and Eric Chen

Part I Personal
  2 The Academic Beginnings of Germán Berrios at the
‘Universidad Nacional Mayor De San Marcos’������������������������������������    9
Jeff Huarcaya-Victoria
  3 Notes on the Work of Professor German E. Berrios����������������������������   21
Augusto C. Castagnini
  4 From Neuropsychiatry to Social Cognition: A Journey
with Berrios����������������������������������������������������������������������������������������������   23
Alejandro García-Caballero and Isabel García-Lado
  5 Conceptual Histories in Psychiatry: Perspectives Across Time,
Language and Culture in the Work of German Berrios����������������������   29
Kenneth C. Kirkby

Part II Epistemological
  6 Critique of Psychopathological Reason: The Work of
G.E. Berrios����������������������������������������������������������������������������������������������   41
Filiberto Fuentenebro and Luis M. Chiva
  7 What Is Psychiatry?��������������������������������������������������������������������������������   57
Ivana S. Marková
  8 Recovering the Context in Psychopathology ����������������������������������������   65
Eric Chen
  9 Stress and Distress in Psychiatry: A Conceptual Analysis ������������������   73
Sergio E. Starkstein

xiii
xiv Contents

10 Cultural Configurators and the Formation of Mental

Symptoms��������������������������������������������������������������������������������������������������   91
Rogelio Luque and J. M. Villagrán Moreno
11 Psychogenesis: Conceptual Analysis������������������������������������������������������ 103
J. M. Villagrán Moreno and Rogelio Luque
12 Supervenience and the Mind-Body Problem in Psychiatry ���������������� 117
Hiroshi Ihara

Part III Historical
13 At the Origins of Hermeneutic Psychopathology���������������������������������� 131
Massimiliano Aragona
14 The Discontents of Psychiatry: What Can the History
of Psychiatry and Values-Based Medicine Contribute
to Resolving Them?���������������������������������������������������������������������������������� 145
Robert Dudas
15 The Origins of Psychiatric Epidemiology in Chile in the
Twentieth Century, as a Tool for Community Action:
An Historical Analysis ���������������������������������������������������������������������������� 153
Rubén Alvarado and Leonel Valdivia
16 The Evolution of Portuguese Psychiatry in the First
Decades of the Twentieth Century���������������������������������������������������������� 163
José Morgado Pereira
17 Recalibrating the Work of Juan Valverde de Amusco
in the Sixteenth-­Century Anatomical Revolution �������������������������������� 171
L. J. Fernández Rodríguez
18 August Wimmer’s Concept: Psychogenic Psychoses,
a Source-Critical Study���������������������������������������������������������������������������� 183
Johan Schioldann

Part IV Psychopathological
19 The Experience of People with Formal Thought Disorder������������������ 199
Alvaro Barrera
20 Paved with Good Intentions: Defining Traumatic Stress
Disorders�������������������������������������������������������������������������������������������������� 213
Arieh Y. Shalev
21 Distortions of Time Experience and Descriptive
Psychopathology�������������������������������������������������������������������������������������� 223
Jorge Carlos Holguín Lew
Contents xv

22 Visual Symbology and Psychopathology in Frida Kahlo’s

Work���������������������������������������������������������������������������������������������������������� 243
María Beatriz Quintanilla-Madero
23 The Contribution of the Cambridge School of Psychopathology
for the Understanding of Psychosomatic Symptoms���������������������������� 255
Lazslo A. Ávila

Part V Neuropsychiatry
24 Researching Wilson’s Disease ���������������������������������������������������������������� 265
Tom Dening
25 Reflections on the Psychopathology of Acquired Brain Injury ���������� 277
Jose Ignacio Quemada

Index������������������������������������������������������������������������������������������������������������������ 289
Contributors

Rubén Alvarado Program of Mental Health, Faculty of Medicine, School of

Public Health, Universidad de Chile, Santiago, Chile
Massimiliano Aragona Independent Researcher, Rome, Italy
Lazslo A. Ávila State Medical College of Sao Jose do Rio Preto, Sao Jose do Rio
Preto, Brazil
Alvaro Barrera Oxford Health Foundation Trust & Department of Psychiatry,
University of Oxford, Oxford, UK
Augusto C. Castagnini Postgraduate School of Child Neuropsychiatry, University
of Modena and Reggio Emilia, Modena, Italy
Eric Chen Department of Psychiatry, University of Hong Kong, Hong Kong, Hong
Kong
Luis M. Chiva Department of Psychiatry, Medical School, Complutense University
(UCM), Madrid, Spain
Tom Dening Division of Psychiatry & Applied Psychology, University of
Nottingham, Nottingham, UK
Robert Dudas Department of Psychiatry, Cambridge, UK
Filiberto Fuentenebro Department of Psychiatry, Medical School, Complutense
University (UCM), Madrid, Spain
Alejandro García-Caballero Department of Psychiatry, University Hospital of
Ourense, Ourense, Spain
Department of Psychiatry, School of Medicine, University of Santiago de
Compostela, Santiago de Compostela, Spain
Isabel García-Lado Department of Psychiatry, University Hospital of Ourense,
Ourense, Spain

xvii
xviii Contributors

Jeff Huarcaya-Victoria Universidad de San Martín de Porres, Facultad de

Medicina, Centro de Investigación en Salud Pública, Lima, Peru
Hiroshi Ihara Department of Psychiatry, Saitama Medical Center, Dokkyo
Medical University, Koshigaya, Saitama, Japan
Kenneth C. Kirkby Department of Psychiatry, University of Tasmania, Hobart,
Australia
Jorge Carlos Holguín Lew Department of Psychiatry, University of Antioquia,
Medellín, Colombia
Rogelio Luque Córdoba Medical School, University of Córdoba, Reina Sofía
University Hospital, Córdoba, Spain
Ivana S. Marková Hull York Medical School, Allam Medical Building, University
of Hull, UK
J. M. Villagrán Moreno Cádiz Medical School, University of Cádiz, Jerez
University Hospital, Jerez de la Frontera, Spain
José Morgado Pereira Centre for Interdisciplinary Studies of the 20th Century,
University of Coimbra, Coimbra, Portugal
Jose Ignacio Quemada Brain Injury Unit, Aita Menni Hospital, Bilbao, Spain
María Beatriz Quintanilla-Madero School of Medicine, Universidad
Panamericana, Mexico City, Mexico
L. J. Fernández Rodríguez National University of Distance Education (UNED),
Tudela, Navarra, Spain
Johan Schioldann Department of Psychiatry, University of Adelaide, Adelaide,
Australia
Arieh Y. Shalev Department of Psychiatry, New York University, New York, NY,
USA
Hadassah and Hebrew University School of Medicine, Jerusalem, Israel
Sergio E. Starkstein Division of Psychiatry, Faculty of Medicine, University of
Western Australia, Perth, Australia
Leonel Valdivia Program of Mental Health, Faculty of Medicine, School of Public
Health, Universidad de Chile, Santiago, Chile
Chapter 1
Introduction

Ivana S. Marková and Eric Chen

Contents
References    5

At the heart of psychiatry lies psychopathology, the language that was created over
the course of the nineteenth century to systematically describe and capture anoma-
lies in mental states and behaviours of those deemed to be mentally disordered
(Berrios 1996). Constructed at a time when the natural sciences were facing chal-
lenges from the newly arising human/social sciences in the search for explanation
of human beings, psychopathology became imbued with the same tensions. As
such, its foundations sit somewhat uneasily between both the natural sciences and
the social/human sciences. This has had lasting and important consequences.
Foremost among these has been the result that understanding and research into psy-
chopathology has tended to polarize and oscillate between approaches that are
either firmly neurobiological on the one hand or social constructionist on the other.
Currently, the neurobiological drive is particularly strong and leads to a narrow and
mechanistic conception of the nature of mental phenomena and underlying psycho-
logical processes.
Eschewing such divisions and taking an original and epistemologically justified
approach, Germán Berrios and his school of psychopathology argue that the foun-
dations of psychopathology need to be understood as hybrid in nature. And, hybrid
has to be understood in the literal sense, that is, in the sense that deeply incongruous
elements are jointly involved in the constitution and structure of psychopathology.
This is the central and crucial thesis. So, what then are these incongruous elements?

I. S. Marková (*)
Hull York Medical School, Allam Medical Building, University of Hull, Hull, UK
E. Chen
Department of Psychiatry, University of Hong Kong, Hong Kong, Hong Kong

© Springer Nature Switzerland AG 2020 1

I. S. Marková, E. Chen (eds.), Rethinking Psychopathology, Theory and History
in the Human and Social Sciences, https://doi.org/10.1007/978-3-030-43439-7_1
2 I. S. Marková and E. Chen

Firstly, there is neurobiology, the material element that forms a medium through
which we can exist and function. There is no disputing that our brains and nervous
systems are necessary for the functioning of our mental processes. Secondly there
is meaning, a fluid-like, non-material element that carries both personal and collec-
tive (family, peer, social, cultural) components. The incongruity is obvious. We have
one element composed of matter, present in time and space and fixed within one
person. We have another element, non-material, non-tangible, present in time but
not the same kind of space and extending beyond the one person. Yet both these ele-
ments are necessary and are woven together to form the clinical phenomena that are
described and captured by the language of psychopathology. Our understanding of
both psychopathology and our research needs to be based on this epistemological
foundation.
This epistemological position does raise certain challenges. Firstly, how such
incongruous elements, the material and the non-material, can be bound to form a
complex remains a question, one, moreover, whose answers must be sought in what
seems like a no man’s land at the interface of science and philosophy.
Acknowledgement of this problem, however, does not obviate the significance of
this fundamental position and its consequences. Indeed, it serves to highlight the
need to recognize that mental states and behaviours are inherently complex. We
would stand to lose a lot in terms of our future understanding and knowledge should
these be reduced to either the neurobiological or the sociocultural. The biopsycho-
social model, so often used in relation to our understanding of mental states and
behaviours, is a pragmatic approach where neurobiological, psychological, and
social factors are all viewed as important influences in the presentation of clinical
phenomena. However, it is not a justified epistemological position. On this model,
the neurobiological, psychological, and social factors work in an additive way rather
than in any real interactive sense.
Secondly, there is the challenge of determining the extent to which each element
might contribute to the structure of individual psychopathological phenomena and
hence give them their structural and clinical salience. Given that psychopathological
structures, whether mental symptoms or disorders, are heterogeneous, it is likely
that there is considerable variation in the degree to which neurobiology and mean-
ing carry the weight or ‘sense’ of the symptom. This is important also because of the
possible therapeutic implications but is a question that may be more amenable to
empirical research.
Thirdly, there is the challenge of addressing, in a serious way, the nature of
meaning, the nebulous, non-material component of psychopathological phenom-
ena. Exploring the meaning underlying mental phenomena and how this may be
configured is a particularly complicated endeavour. It entails an approach that draws
on history, psychology, culture, linguistics, anthropology, and hermeneutics among
others. In addition, however, it involves a twofold interrelated exploration in which
simultaneously the content or sense of the meaning is sought along with how it
becomes configured in the first place. Understanding the nature and role of such
configurators becomes particularly relevant when making sense of psychopatho-
logical phenomena and their development.
1 Introduction 3

Building on this hybrid epistemology and its challenges underlying psychopa-

thology, Germán Berrios has been the central figure and creative pioneer. Through
his teaching and collaborations with students and colleagues from all over the
world, he has developed a rich and original framework on which this field continues
to grow and evolve. An inspirational scholar and teacher, whose thinking cuts across
subject domains and professional disciplines and whose imaginative ideas forge
new paths in the exploration of reality, Berrios makes us question assumptions,
helps us examine concepts and phenomena in novel ways, and stimulates in all of us
new questions and new directions of enquiries. His contribution to psychopathology
is immense, seen through not only his substantive and significant outputs such as his
acclaimed History of Mental Symptoms (1996) but in the publication of an extensive
body of original articles. There, among other things, he provides conceptual analy-
ses on mental symptoms, showing how historical, cultural, and psychological fac-
tors contribute to their construction and how and why this is made possible within
specific historical epistemes (e.g. Berrios 1981, 1988, 1990, 1995, 1998, 1999). His
journal, History of Psychiatry, started with Roy Porter is renowned for its epistemo-
logical focus as well as historical depth. His wealth and breadth of knowledge in
history, philosophy, psychology, statistics, and psychiatry has attracted students and
colleagues from all over the world. Much of the resultant collaborative work has
become known as the Cambridge school of psychopathology.
This volume is a small homage from some of his students and colleagues. We are
all too aware that we have not been able to include everybody who would have
wanted to contribute. We have had to rely on the contacts we knew about or found
out about from others, and this task was complicated by the fact that his collabora-
tors spanned not only geographical distances but also generations. We apologize to
those we have been unable to contact. As such, the contributors here come from all
continents of the world, and the chapters focus on different aspects of the broad
transdisciplinary approach to the exploration of psychopathology as developed by
Germán Berrios and the Cambridge school of psychopathology.
Despite not being fully representative from the perspective of contributor inclu-
sion, in other ways the chapters that follow reflect very much the multifaceted and
variegated approaches to the study of psychopathology and related areas that char-
acterize and/or are inspired by the work and ideas of Germán Berrios. The contribu-
tions are diverse. There is no particular underlying theme around which the chapters
are focused. Instead, each chapter brings its own particular interest and emphasis.
Each addresses its own specific issues. We thus have a mosaic of articles whose
common link is that they have each been influenced in one way or another by the
work and ideas of Berrios.
We have divided the volume into parts for ease of reference. However, reflecting
the consequences of a root hybrid epistemology, many of the chapters do overlap
these divisions both in content and in approach. The first part is a personal one. It
begins with an account of some of the early background factors important in the
work and development of ideas of Berrios (Huarcaya-Victoria). This is followed by
three separate recollections of working with Berrios, each giving a different slant on
their experiences (Castagnini; García Caballero & García Lado; Kirkby).
4 I. S. Marková and E. Chen

The second part deals with epistemological enquiries. Here we begin with a
detailed analysis of some of the main threads underlying the psychopathological
work of Berrios (Fuentenebro & Chiva). After this, there are chapters that address
specific epistemological problems relating to psychopathology. Here we first delve
into the question of how can we define or understand psychiatry (Marková). Then,
we discuss the nature and importance of contextual factors in descriptive psychopa-
thology (Chen). This is followed by consideration of the role of conceptual analysis
in psychiatric nosology, illustrating this specifically with the concepts of stress and
distress (Starkstein). The meaning and role of cultural configurators in the construc-
tion of mental symptoms are then examined (Luque & Villagrán), followed by an
analysis of the problem of psychogenesis (Villagrán & Luque). Finally, in this part,
Ihara explores the concept of supervenience and the mind-body problem in
depression.
The third part addresses psychopathology and related medical areas from a his-
torical perspective. Again these represent diverse areas of study. Aragona offers an
examination of hermeneutic psychopathology, emphasizing its relevance and ubiq-
uity and exploring its historical roots in order that we can develop better ways of
making sense of patients’ experiences. Other chapters are more narrowly focused
on specific historical studies. Thus we have an account of the development of epide-
miological studies into psychopathological syndromes over a 15-year period in par-
ticular regions of Santiago, Chile (Alvarado & Valdivia), a description of how
psychiatry and psychopathology evolved in Portugal between 1915 and 1940
(Pereira), and there is a historical reassessment of the contribution to medicine of
Valverde, a sixteenth-century Spanish anatomist (Rodríguez). Taking a different
approach, Dudas focuses on the relevance of historical understanding for the prac-
tising clinician. And Schioldann completes this part with a detailed analysis of
Wimmer’s concept of psychogenic psychoses.
The fourth part is more specifically focused on psychopathology, and the chap-
ters here again explore various and distinct aspects of this. Thus one chapter exam-
ines the concept of formal thought disorder and argues for the need to explore
possible meaning hidden in or symbolized through this psychopathological phe-
nomenon in order to enhance communication with patients (Barrera). Then there is
a critical exploration of the concept of post-traumatic stress disorder and the debates
this syndrome generates (Shalev). This is followed by a chapter focusing specifi-
cally on the notion of time in psychopathology, exploring the contribution of time
distortions to psychopathological phenomena (Holguin Lew). In a completely dif-
ferent vein, we have an analysis of the symbology in Frida Kahlo’s art and its pos-
sible associations with psychopathology (Quintanilla-Madero). Lastly, the chapter
by Avila seeks to apply the Cambridge school of psychopathology model of symp-
tom formation to the development of medically unexplained symptoms.
The final part contains two chapters focusing on neuropsychiatric aspects of psy-
chopathology. Here, some of the issues concerning the disentangling of neurobiol-
ogy and meaning alluded to earlier can be more concretely raised in relation to