Guilherme Messas - Academia.edu (original) (raw)
Papers by Guilherme Messas
The Lancet Psychiatry, Sep 1, 2022
There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causa... more There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry have been met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges.
Frontiers in Psychology
The clinical presentation of obsessive–compulsive patients is characterized by unwanted, intrusiv... more The clinical presentation of obsessive–compulsive patients is characterized by unwanted, intrusive, nonsensical, self-related, and recurrent ideas, thoughts, images, or impulses associated with active compulsive compensations. Under the operational diagnostic criteria adopted by the biological- and cognitive-oriented neopositivist medical paradigm, it is known as “obsessive–compulsive disorder.” However, this paradigm has been criticized for its controversial assumptions, limited methodologies, theoretic biases, and inconsistency in producing practical outcomes. To bypass some of these issues, we propose a complementary approach that draws on and further develops existing psychopathological studies of the obsessive–compulsive anthropological condition based on dialectical phenomenological psychopathology. As such, we refer to the global clinical configuration as the “obsessive–compulsive existential type.” Our theoretical inspiration comes from the classical phenomenological work on...
Frontiers in Psychiatry
In this paper, we present how a dialectical perspective on phenomenological psychopathology, call... more In this paper, we present how a dialectical perspective on phenomenological psychopathology, called Dialectical Phenomenology (DPh), can contribute to current needs of psychiatric diagnosis. We propose a three-stage diagnostic methodology: first- and second-person stages, and synthetic hermeneutics stage. The first two stages are divided into a pre-dialectical and a dialectical phase. The diagnostic process progresses in a trajectory of increasing complexity, in which knowledge obtained at one level is dialectically absorbed and intertwined into the next levels. Throughout the article, we offer some examples of each step. In overall, the method starts off from the patient's own narrative, proceeds to two stages of phenomenological reduction designed to guarantee the scientific validity of the object, and concludes with a hermeneutical narrative synthesis that is dialectically composed of the patient's and psychopathologist's shared narratives. At the end of this process,...
Revista Psicopatologia Fenomenológica Contemporânea
A proposta do presente artigo é discutir a contribuição de Eugène Minkowski e Ludwig Binswanger p... more A proposta do presente artigo é discutir a contribuição de Eugène Minkowski e Ludwig Binswanger para se pensar a entidade nosológica “esquizofrenia”. Para isso, é realizada uma reconstrução histórica a respeito de sua essência: Emil Kraepelin a considera uma deterioração das faculdades psíquicas, enquanto Eugen Bleuler a entende como cisão dessas faculdades (Spaltung). Eugène Minkowski, por sua vez, considera que o trouble générateur do transtorno é o autismo; ele entende a esquizofrenia como perda do contato vital com a realidade, em que há falta de sintonia com o ambiente. Ludwig Binswanger também dá destaque ao autismo, ainda que não o considere exclusivo da esquizofrenia; ele fala da inadequação à rede de referências constituídas intersubjetivamente, o que caracteriza a excentricidade esquizofrênica.
Psychopathology, 2019
Despite the significant need for coordinated approaches to the treatment of substance misuse worl... more Despite the significant need for coordinated approaches to the treatment of substance misuse worldwide, there are still major gaps in both the provision of services and in the development of a theoretically unified approach to care. We suggest that a phenomenological approach to care can provide comprehensive, theoretically grounded guidelines that coordinate and help choose between a range of interventions while respecting the values of the patient and other stakeholders. The aim of this paper is to present a framework for a person-centered approach to substance misuse care, based on general principles of phenomenology. In particular, we emphasize a dialectic conception of phenomenological care, one that considers the various tensions and conflicts of human life, and the ways these are managed by individuals. Two dialectics are presented here: the dialectic of anthropological proportions, involved in the existential situation of the substance misuser, and the dialect of decision, w...
Psychiatric Genetics, 2005
Genetic factors play a role in the vulnerability to cocaine dependence. The reinforcing propertie... more Genetic factors play a role in the vulnerability to cocaine dependence. The reinforcing properties of cocaine are related to the dopaminergic system, and, in particular, the dopamine receptors have been linked to the reward mechanisms. The present study examines the role of the variants TaqI A of the dopamine D2 receptor gene and BalI of the dopamine D3 receptor gene in a Brazilian sample consisting of 730 cocaine dependents and 782 healthy controls. The studied polymorphisms did not show any difference in allelic frequencies or genotypic distribution between the groups. Our data do not support a role for the dopamine D2 receptor gene TaqI A and dopamine D3 receptor gene BalI gene polymorphisms in the susceptibility to cocaine dependence in a Brazilian sample.
![Research paper thumbnail of [Lack of gender effect on familial schizophrenia. A Brazilian study]](https://attachments.academia-assets.com/101736597/thumbnails/1.jpg)
](Arquivos de neuro-psiquiatria, 2000
Epidemiological studies on schizophrenia have showed different age at onset between gender, in wh... more Epidemiological studies on schizophrenia have showed different age at onset between gender, in which male schizophrenics present symptoms earlier than females. However this gender effect is not observed within familial schizophrenia. The present study investigates the age at onset in 31 RDC-schizophrenics from 13 Brazilian families. No differences in age at onset were found between gender, confirming previous studies in other populations. This result may indicate genetic influences on age at onset in a subgroup of patients affected by schizophrenia and can be explored by molecular genetic studies.
SUCHT
: Aim: The article presents the basic tenants of dialectical phenomenological psychopathology (DP... more : Aim: The article presents the basic tenants of dialectical phenomenological psychopathology (DPP) of temporal experience in substance-related disorders. Results: DPP examines the conditions of possibility of lived experiences. It goes beyond mere qualitative descriptions of subjective psychological states to identify their pre-reflective structures. The modifications of these structures are considered essential to mental disorders, including additions. The paper argues that the phenomenon of addiction arises when there is a failure of the dynamic process of temporal balances and imbalances between the dimensions of lived past, present, and future. In such an altered state, the present pathologically dominates over past and future. Personal history and future consequences of intoxicated behaviour are disregarded. The future in particular loses its ‘normal’ characteristic of a probable horizon of present experience and becomes ‘actualized’ as present continuous. At the same time, a part of the future ‘dissociates’ from the present objective situation and becomes improbable. To substantiate these claims, the article presents four case vignettes of clients suffering from such pathological entanglement of temporal dimensions. Conclusions: DPP may be seen as an invaluable approach to examine the dialectical structure of human experience. As such, it constitutes a promising paradigm for the 21st century person-centered psychiatry.
The Existential Structure of Substance Misuse, 2021
Clinical Neuropsychiatry, 2021
Substance use is one of the major issues of current public health, as being responsible for a sig... more Substance use is one of the major issues of current public health, as being responsible for a significant share of the global burden of disease (GBD, 2016). As such, it seems reasonable that understanding the characteristics of substance use disorders (SUD) is of utmost importance for public health worldwide. However, defining the features of these disorders has proved to represent a difficult challenge. Although the array of SUD has long been part of official classification systems (such as International Classification of Diseases – ICD, or Diagnostic and Statistical Manual of Mental Disorders – DSM), there is no consensus regarding some of their crucial aspects, as their nature or major causes. These controversies may determine pragmatic consequences for mental health (Hall et al., 2015): for example, if addiction is understood as a brain disease, society tends to be more tolerant of addicted persons than if it is understood as the result of a fully voluntary behaviour. My opinion...
MEDICA REVIEW International Medical Humanities Review, 2022
The Existential Structure of Substance Misuse, 2021
A presente entrevista ocorreu no mes de novembro entre os entrevistadores Victor Portugal e Andre... more A presente entrevista ocorreu no mes de novembro entre os entrevistadores Victor Portugal e Andre Fukuda com o Prof. Dr. Guilherme Messas. O dialogo buscou explorar desde questoes basicas pertinentes a psicopatologia fenomenologica ate mesmo debates e opinioes contemporâneos presentes na literatura. De forma geral, o Prof. Messas buscou ao longo da entrevista definir e defender a psicopatologia fenomenologica nao como unica opcao hegemonica dentro do campo, mas sim como um interessante caminho que se mantem proximo da experiencia humana, que analisa as estruturas da subjetividade e que tem um alto valor clinico. Prof. Messas ressaltou diversas vezes que a psicopatologia fenomenologica nao e contraria aos estudos em biologia ou farmacologia, oposicao elevada muitas vezes erroneamente em diversos contextos teorico e praticos, mas que pode sim haver uma relacao mutuamente benefica. O que a psicopatologia fenomenologica se opoe e, na verdade, o que o Professor intitulou “operacionalismo...
The Lancet Psychiatry, Sep 1, 2022
There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causa... more There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry have been met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges.
Frontiers in Psychology
The clinical presentation of obsessive–compulsive patients is characterized by unwanted, intrusiv... more The clinical presentation of obsessive–compulsive patients is characterized by unwanted, intrusive, nonsensical, self-related, and recurrent ideas, thoughts, images, or impulses associated with active compulsive compensations. Under the operational diagnostic criteria adopted by the biological- and cognitive-oriented neopositivist medical paradigm, it is known as “obsessive–compulsive disorder.” However, this paradigm has been criticized for its controversial assumptions, limited methodologies, theoretic biases, and inconsistency in producing practical outcomes. To bypass some of these issues, we propose a complementary approach that draws on and further develops existing psychopathological studies of the obsessive–compulsive anthropological condition based on dialectical phenomenological psychopathology. As such, we refer to the global clinical configuration as the “obsessive–compulsive existential type.” Our theoretical inspiration comes from the classical phenomenological work on...
Frontiers in Psychiatry
In this paper, we present how a dialectical perspective on phenomenological psychopathology, call... more In this paper, we present how a dialectical perspective on phenomenological psychopathology, called Dialectical Phenomenology (DPh), can contribute to current needs of psychiatric diagnosis. We propose a three-stage diagnostic methodology: first- and second-person stages, and synthetic hermeneutics stage. The first two stages are divided into a pre-dialectical and a dialectical phase. The diagnostic process progresses in a trajectory of increasing complexity, in which knowledge obtained at one level is dialectically absorbed and intertwined into the next levels. Throughout the article, we offer some examples of each step. In overall, the method starts off from the patient's own narrative, proceeds to two stages of phenomenological reduction designed to guarantee the scientific validity of the object, and concludes with a hermeneutical narrative synthesis that is dialectically composed of the patient's and psychopathologist's shared narratives. At the end of this process,...
Revista Psicopatologia Fenomenológica Contemporânea
A proposta do presente artigo é discutir a contribuição de Eugène Minkowski e Ludwig Binswanger p... more A proposta do presente artigo é discutir a contribuição de Eugène Minkowski e Ludwig Binswanger para se pensar a entidade nosológica “esquizofrenia”. Para isso, é realizada uma reconstrução histórica a respeito de sua essência: Emil Kraepelin a considera uma deterioração das faculdades psíquicas, enquanto Eugen Bleuler a entende como cisão dessas faculdades (Spaltung). Eugène Minkowski, por sua vez, considera que o trouble générateur do transtorno é o autismo; ele entende a esquizofrenia como perda do contato vital com a realidade, em que há falta de sintonia com o ambiente. Ludwig Binswanger também dá destaque ao autismo, ainda que não o considere exclusivo da esquizofrenia; ele fala da inadequação à rede de referências constituídas intersubjetivamente, o que caracteriza a excentricidade esquizofrênica.
Psychopathology, 2019
Despite the significant need for coordinated approaches to the treatment of substance misuse worl... more Despite the significant need for coordinated approaches to the treatment of substance misuse worldwide, there are still major gaps in both the provision of services and in the development of a theoretically unified approach to care. We suggest that a phenomenological approach to care can provide comprehensive, theoretically grounded guidelines that coordinate and help choose between a range of interventions while respecting the values of the patient and other stakeholders. The aim of this paper is to present a framework for a person-centered approach to substance misuse care, based on general principles of phenomenology. In particular, we emphasize a dialectic conception of phenomenological care, one that considers the various tensions and conflicts of human life, and the ways these are managed by individuals. Two dialectics are presented here: the dialectic of anthropological proportions, involved in the existential situation of the substance misuser, and the dialect of decision, w...
Psychiatric Genetics, 2005
Genetic factors play a role in the vulnerability to cocaine dependence. The reinforcing propertie... more Genetic factors play a role in the vulnerability to cocaine dependence. The reinforcing properties of cocaine are related to the dopaminergic system, and, in particular, the dopamine receptors have been linked to the reward mechanisms. The present study examines the role of the variants TaqI A of the dopamine D2 receptor gene and BalI of the dopamine D3 receptor gene in a Brazilian sample consisting of 730 cocaine dependents and 782 healthy controls. The studied polymorphisms did not show any difference in allelic frequencies or genotypic distribution between the groups. Our data do not support a role for the dopamine D2 receptor gene TaqI A and dopamine D3 receptor gene BalI gene polymorphisms in the susceptibility to cocaine dependence in a Brazilian sample.
Arquivos de neuro-psiquiatria, 2000
Epidemiological studies on schizophrenia have showed different age at onset between gender, in wh... more Epidemiological studies on schizophrenia have showed different age at onset between gender, in which male schizophrenics present symptoms earlier than females. However this gender effect is not observed within familial schizophrenia. The present study investigates the age at onset in 31 RDC-schizophrenics from 13 Brazilian families. No differences in age at onset were found between gender, confirming previous studies in other populations. This result may indicate genetic influences on age at onset in a subgroup of patients affected by schizophrenia and can be explored by molecular genetic studies.
SUCHT
: Aim: The article presents the basic tenants of dialectical phenomenological psychopathology (DP... more : Aim: The article presents the basic tenants of dialectical phenomenological psychopathology (DPP) of temporal experience in substance-related disorders. Results: DPP examines the conditions of possibility of lived experiences. It goes beyond mere qualitative descriptions of subjective psychological states to identify their pre-reflective structures. The modifications of these structures are considered essential to mental disorders, including additions. The paper argues that the phenomenon of addiction arises when there is a failure of the dynamic process of temporal balances and imbalances between the dimensions of lived past, present, and future. In such an altered state, the present pathologically dominates over past and future. Personal history and future consequences of intoxicated behaviour are disregarded. The future in particular loses its ‘normal’ characteristic of a probable horizon of present experience and becomes ‘actualized’ as present continuous. At the same time, a part of the future ‘dissociates’ from the present objective situation and becomes improbable. To substantiate these claims, the article presents four case vignettes of clients suffering from such pathological entanglement of temporal dimensions. Conclusions: DPP may be seen as an invaluable approach to examine the dialectical structure of human experience. As such, it constitutes a promising paradigm for the 21st century person-centered psychiatry.
The Existential Structure of Substance Misuse, 2021
Clinical Neuropsychiatry, 2021
Substance use is one of the major issues of current public health, as being responsible for a sig... more Substance use is one of the major issues of current public health, as being responsible for a significant share of the global burden of disease (GBD, 2016). As such, it seems reasonable that understanding the characteristics of substance use disorders (SUD) is of utmost importance for public health worldwide. However, defining the features of these disorders has proved to represent a difficult challenge. Although the array of SUD has long been part of official classification systems (such as International Classification of Diseases – ICD, or Diagnostic and Statistical Manual of Mental Disorders – DSM), there is no consensus regarding some of their crucial aspects, as their nature or major causes. These controversies may determine pragmatic consequences for mental health (Hall et al., 2015): for example, if addiction is understood as a brain disease, society tends to be more tolerant of addicted persons than if it is understood as the result of a fully voluntary behaviour. My opinion...
MEDICA REVIEW International Medical Humanities Review, 2022
The Existential Structure of Substance Misuse, 2021
A presente entrevista ocorreu no mes de novembro entre os entrevistadores Victor Portugal e Andre... more A presente entrevista ocorreu no mes de novembro entre os entrevistadores Victor Portugal e Andre Fukuda com o Prof. Dr. Guilherme Messas. O dialogo buscou explorar desde questoes basicas pertinentes a psicopatologia fenomenologica ate mesmo debates e opinioes contemporâneos presentes na literatura. De forma geral, o Prof. Messas buscou ao longo da entrevista definir e defender a psicopatologia fenomenologica nao como unica opcao hegemonica dentro do campo, mas sim como um interessante caminho que se mantem proximo da experiencia humana, que analisa as estruturas da subjetividade e que tem um alto valor clinico. Prof. Messas ressaltou diversas vezes que a psicopatologia fenomenologica nao e contraria aos estudos em biologia ou farmacologia, oposicao elevada muitas vezes erroneamente em diversos contextos teorico e praticos, mas que pode sim haver uma relacao mutuamente benefica. O que a psicopatologia fenomenologica se opoe e, na verdade, o que o Professor intitulou “operacionalismo...