Bedingungskonstellationen Paranoid-Halluzinatorischer Syndrome: Zugleich Ein Methodischer Beitrag Zur Untersuchung Psychopathologisch-Elektrencephalog
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"Die durch Symptome und Verlauf repräsentierten Krankheitsbestandteile, die Zusammenhänge, in die sie eingefügt sind, die Vorgänge, aus denen sie sich ergeben, die Faktoren, durch die sie bedingt sind . -. machen in der Besonderheit ihres Zusam- menhanges . . . das Wesen des klinischen Aufbaues der Psychose aus. " Dieser Satz, den K. BIRNBAUM 1919 schrieb, ist aus der klinischen Erfahrung abgeleitet, einer Erfah- rung, die im Laufe der Jahre immer wieder in theoretischen Konzepten [6,7,79, 124, 125, 138, 195, 198, 214] und kasuistischen Darstellungen [4, 55, 83, 174, 175] Ausdruck gefunden hat. Es blieb jedoch bei kasuistischen Evidenz-Erlebnissen und der Illustration von Denkmöglichkeiten mit klinischen Fakten; die in dieser Anschauung enthaltene methodische Vorschrift für die Analyse der komplexen klinischen Gegeben- heiten wurde hingegen bisher kaum befolgt, aus theoretischen Gründen einerseits, aus methodischen und praktischen Gründen andererseits. 1. 1 Das psychiatrische Problem Ein theoretisches Hindernis hatte BIRNBAUM [22] selbst aufgebaut. Mit der Tren- nung in pathogenetische und pathoplastische Faktoren postulierte er eine Hierarchie der Faktoren, die der Psychose zugrunde liegen könnten. RÜMKE [171] wies darauf hin, da eine so verstandene Strukturanalyse in die Richtung monokausalen Denkens drängt, da der pathogenetische Faktor schlie lich als einziger kausaler Faktor er- scheint. Die Suche nach einem pathogenetischen Faktor aber steht der Analyse einer Vielzahl von Faktoren und deren Zusammenhang mit dem Aufbau der Psychose zwangsläufig entgegen.
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