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      Los trastornos mentales de nietzsche: locura, estar enfermo, “llega a ser el que eres” Translated title: nietzsche's mental disorders: madness, being sick, “how to become what you are”

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          Abstract

          Resumen Desde su niñez Nietzsche padeció de variadas enfermedades y desde esa época intentó aprehender el significado de “¿Qué sentido tiene el enfermar”? 1] Durante sus últimos años desarrolló una demencia progresiva diagnosticada como parálisis progresiva atípica, pero los avances en la genética molecular han puesto en duda el concepto original. 2] Su historia médica consistió en numerosos problemas graves que incluyó cefaleas persistentes, alteraciones gástricas con fuerte impacto en su vida cotidiana, pérdida progresiva de la visión, reumatismo, alteraciones afectivas intermitentes. 3] Ser enfermo para Nietzsche es un proyecto de mundo, el modo y manera en el cual se tornan accesibles los entes para él, que resultó en un estrechamiento, constricción, expansión o modo creativo de ser-en-el-mundo

          Translated abstract

          Nietzsche suffered from his chilhood of several diseases and ever since he tried to apprehend the meaning of the question “What means to be ill”? 1] During his last years a profound progressive dementia evolved diagnosed as atypical paralysis progressiva, but developments in molecular genetics have questioned the original concept. 2] Nietzsche's medical history consisted of several mayor problems including headaches persisting for several hours, gastric disturbances having a major impact on his daily life, a progressive loss of visual acuity, rheumatism, intermittent mood disorders. 3] To be ill for Nietzsche was a world-project, the mode and manner in which beings were accessible to him, that resulted in a narrowing, constricting, expanding or creative way of being-in-the-world.

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          Most cited references45

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          The nature of psychiatric disorders.

          A foundational question for the discipline of psychiatry is the nature of psychiatric disorders. What kinds of things are they? In this paper, I review and critique three major relevant theories: realism, pragmatism and constructivism. Realism assumes that the content of science is real and independent of human activities. I distinguish two "flavors" of realism: chemistry-based, for which the paradigmatic example is elements of the periodic table, and biology-based, for which the paradigm is species. The latter is a much better fit for psychiatry. Pragmatism articulates a sensible approach to psychiatric disorders just seeking categories that perform well in the world. But it makes no claim about the reality of those disorders. This is problematic, because we have a duty to advocate for our profession and our patients against other physicians who never doubt the reality of the disorders they treat. Constructivism has been associated with anti-psychiatry activists, but we should admit that social forces play a role in the creation of our diagnoses, as they do in many sciences. However, truly socially constructed psychiatric disorders are rare. I then describe powerful arguments against a realist theory of psychiatric disorders. Because so many prior psychiatric diagnoses have been proposed and then abandoned, can we really claim that our current nosologies have it right? Much of our current nosology arose from a series of historical figures and events which could have gone differently. If we re-run the tape of history over and over again, the DSM and ICD would not likely have the same categories on every iteration. Therefore, we should argue more confidently for the reality of broader constructs of psychiatric illness rather than our current diagnostic categories, which remain tentative. Finally, instead of thinking that our disorders are true because they correspond to clear entities in the world, we should consider a coherence theory of truth by which disorders become more true when they fit better into what else we know about the world. In our ongoing project to study and justify the nature of psychiatric disorders, we ought to be broadly pragmatic but not lose sight of an underlying commitment, despite the associated difficulties, to the reality of psychiatric illness.
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            What kinds of things are psychiatric disorders?

            This essay explores four answers to the question 'What kinds of things are psychiatric disorders?' Essentialist kinds are classes whose members share an essence from which their defining features arise. Although elegant and appropriate for some physical (e.g. atomic elements) and medical (e.g. Mendelian disorders) phenomena, this model is inappropriate for psychiatric disorders, which are multi-factorial and 'fuzzy'. Socially constructed kinds are classes whose members are defined by the cultural context in which they arise. This model excludes the importance of shared physiological mechanisms by which the same disorder could be identified across different cultures. Advocates of practical kinds put off metaphysical questions about 'reality' and focus on defining classes that are useful. Practical kinds models for psychiatric disorders, implicit in the DSM nosologies, do not require that diagnoses be grounded in shared causal processes. If psychiatry seeks to tie disorders to etiology and underlying mechanisms, a model first proposed for biological species, mechanistic property cluster (MPC) kinds, can provide a useful framework. MPC kinds are defined not in terms of essences but in terms of complex, mutually reinforcing networks of causal mechanisms. We argue that psychiatric disorders are objectively grounded features of the causal structure of the mind/brain. MPC kinds are fuzzy sets defined by mechanisms at multiple levels that act and interact to produce the key features of the kind. Like species, psychiatric disorders are populations with central paradigmatic and more marginal members. The MPC view is the best current answer to 'What kinds of things are psychiatric disorders?'
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              Evolutionary versus prototype analyses of the concept of disorder.

              The harmful dysfunction (HD) analysis of the concept of disorder (J. C. Wakefield, 1992a) holds that disorders are harmful failures of internal mechanisms to perform their naturally selected functions. S. O. Lilienfeld and L. Marino (1995) proposed instead that disorder is a Roschian prototype concept without defining properties. Against the HD analysis, they argued that many disorders are not failures of naturally selected functions because they are either designed reactions (e.g., fever) or failures of functions that are not naturally selected (e.g., reading disorder). The HD analysis is defended here against these and other objections and compared with the Roschian account. It is argued that the objections are based on conceptual confusions and can be turned around to provide strong new support for the HD analysis. A series of conceptual experiments demonstrates the superior explanatory power of the HD analysis and disconfirms the Roschian account.
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                Author and article information

                Journal
                rchnp
                Revista chilena de neuro-psiquiatría
                Rev. chil. neuro-psiquiatr.
                Sociedad de Neurología, Psiquiatría y Neurocirugía (Santiago, , Chile )
                0717-9227
                December 2020
                : 58
                : 4
                : 363-371
                Affiliations
                [1] Valparaíso orgnameUniversidad de Valparaíso orgdiv1Escuela de Medicina orgdiv2Departamento de Psiquiatría Chile
                Article
                S0717-92272020000400363 S0717-9227(20)05800400363
                eb70c77f-2b74-4dbd-9b4f-5625bf6d98eb

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 20 February 2020
                : 06 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 9
                Product

                SciELO Chile

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Artículo de Revisión

                genius,humanism,creative disease,mental disorder,dementia,Nietzsche

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