Jaspers on “Primary” Delusions

Gorski’s paper (2012) is a conceptual analysis of the famous § 4 (entitled “Delusion and Awareness of Reality”) of Chapter I (“Subjective Phenomena of Morbid Psychic Phenomena”), Section One (“Abnormal Psychic Phenomena”) of Karl Jaspers’ General Psycho-pathology (1913). The author of this paper is not interested in giving his own account or definition of the phenomenon ‘delusion’; rather, his purpose is to explain Jaspers’ critique of Imperial Germany definitions of ‘delusion’ and what he really meant by saying “delusion is a primary phenomenon” (Jaspers 1913, p. 93; English translation, emphasis added). For this specific, quasi-philological focus on the conceptual tools used by Jaspers, not on the phenomenon ‘delusion’ itself, clinicians may be disappointed in reading this paper. Nonetheless, I think that it is an important contribution for all those readers who are interested in the definition of delusion and especially in Jaspers’ concept of ununderstandability applied to so-called primary delusions.

My commentary focuses on this last issue: what does Jaspers’ assertion “delusion is a primary phenomenon” really mean? In footnote (1), Gorski argues that Jaspers probably used the term ‘primary’ not only, or not simply, in one of the established medical senses, that is, to mean that delusion proper are not pathogenetically derivable from more basic abnormal phenomena—for example, as it was used by Eugen Bleuler (1911) when talking about the primary symptoms of schizophrenia, or by Huber (1983) in his hypothesis of schizophrenic basic symptoms. He affirms that when Jaspers stated that delusion was a “primary phenomenon” he was using the term ‘primary’ in a long-established philosophical sense. He suggests that what Jaspers really wanted to tell us was that “A_n, the pathological . . . had no parts, and, consequently, could not be analyzed—or, to put that another way, could not be defined” (Gorski 2012, 86).

These statements conflict with almost one century of exegesis of Jaspers’ writings about delusions and with textbook definitions of delusions, because it simply affirms that according to Jaspers there cannot be a definition of delusion, and especially of delusion proper. To recapitulate Gorski’s argument (as I understand it):

• • He supposes that in Germany, in the nineteenth century, by ‘definition’ philosophers and scientists (including psychiatrists) meant an analysis— hat is, a taking apart—either of a concept, or of a thing, or of the meaning of a word. He assumes that Jaspers too acquired the methodological cast of mind associated with this definition of ‘definition.’

• • He states that delusions proper (only delusion proper) were considered by Jaspers to be pathologically falsified judgments, and that he supplied three legitimate propria for them: being unmediated by thought (unmittlebar), ununderstandable (unverstän- dlich), and accompanied by a change in “the totality of understandable connections” (das Ganze der verständlichen Zusammenhänge) that (to Jaspers) is personality.

• • He concludes that delusion proper is not just a primary phenomenon in the medical sense (i.e., non-reducible to other known phenomena in an explanatory chain); rather, it is primary in the philosophical sense since the “specific difference” of delusion proper—the “pathological”—has no parts, and, consequently, cannot be analyzed. Hence it cannot be defined in the technical sense of this term.

I mainly consider two questions addressed by the author and make some suggestions about them: (1) how Jaspers used the term ‘primary’ in § 4 of General Psychopathology, and (2) what Jaspers meant by ‘pathological’ in this context.

First, Jaspers used the word ‘primary’ about 17 times in § 4. I am afraid that in this paragraph the use of ‘primary’ may be rather inconsistent. For instance, at p. 96 he writes:

When investigating, therefore, we are always confronted with the question—what is the primary experience traceable to the illness and what in the formulation of the judgment is secondary and understandable in terms of that experience?

(emphasis added).

In this sentence, Jaspers seems to use ‘primary’ in the medical sense of the term, that is, contrary to secondary. Here the opposition between explaining and understanding, and the concept of ‘process’ are fundamental to understand Jaspers’ statement. The primary experience traceable to the illness is that experience...