Reassessing the usefulness of “contact” in psychiatry. From the Praecox Gefülh to a typification tool for pathological forms of human existence

Objectives

The clinician who adopts a psychoanalytic approach in a psychiatric context often regards the encounter between two individuals as an interplay of subjectivities, whose mode of being-in-the-world is shaped by their unique historical experiences. Despite some psychoanalytic authors exploring the concept of “contact”, it has often been reduced to its similarity with transference and countertransference, with little attention given to its distinctive qualities. This limits psychoanalysis in its ability to conceptualize an unmediated, preverbal encounter between two individuals. In this article, we argue that the dimension of “contact” cannot be equated with transference, and that it constitutes a vital tool for diagnosing and guiding therapy for various clinical conditions commonly encountered in psychiatry.

Method

This article is based on theoretical considerations. We first worked on the history of the concept of contact, then of Praecox Gefühl in the works of H.C. Rümke, to which we added the findings of current studies on the relevance of Praecox Gefühl in the diagnosis of schizophrenia and the study of the works of the great phenomenological psychiatrists. In so doing, we aimed to show that contact could be a tool of great use for psychiatric diagnosis, insofar that it allows for a typification of the forms of existence of different patients.

Results

H.C. Rümke's investigation of the concept of Praecox Gefühl highlights the unique mode of contact observed in schizophrenia. It is distinct from the feeling of strangeness and involves an intuitive observation of a perceived distance within the clinical relationship. Given that many psychiatric pathologies can cause patients to withdraw from the shared world, we suggest that the notion of Praecox Gefühl, beyond its original designation of the clinician's experience of schizophrenic dissociation and the particularities of the schizophrenic mode of being-in-the-world, may be applicable to other pathologies studied in psychiatric phenomenology. We propose four main forms of contact: the loss of vitality in schizophrenia, the untraceable authenticity of the hysteric, the impossible fluidity in the melancholic, and the failure of anchorage in mania. By approaching contact as a fractal form that reveals the entire mode of the subject's being-in-the-world, this typifying approach goes beyond a purely semiological or etiological reflection and can be diagnostically useful in guiding therapeutic efforts to enhance the subject's capacity to truly engage with others.

Discussion

Our paper focuses on the relationship between contact and what clinicians commonly refer to as an “encounter.” It is important to recognize that contact is not always equivalent to an encounter, and that assuming otherwise risks overlooking the possibility that certain relational modalities could actively prevent such an encounter from taking place. These “anti-contact” modalities, exemplified by the Praecox Gefühl, necessitate a focus on the very possibility of being in a therapeutic relationship with the clinician. Therefore, we suggest that clinicians should work to establish the possibility of being in a relation with the patient, prior to attempting to create an encounter. This approach allows for a more nuanced understanding of the ways in which patients can either facilitate or hinder the development of an encounter, and highlights the importance of working on establishing the possibility of a real encounter and being-with the clinician.

Conclusion

This paper has sought to challenge the prevailing assumption among psychoanalytically oriented clinicians that contact is merely a sub-dimension of the transferential dynamic. Instead, we have argued that contact warrants specific attention as a tool for both diagnosis and therapy in psychiatry. By examining the example of the Praecox Gefülh, we have proposed a typifying approach that could be applied to the most common clinical entities encountered in psychiatry, based on the clinician's perception of specific modalities of contact within the therapeutic consultation. This reflection on contact and anti-contact is a necessary and contemporary contribution to the psychiatric field, which is increasingly embracing a dimensional approach to psychological pathologies. By prioritizing the dimension of contact, we can deepen our understanding of the nuances of the therapeutic relationship and can enhance our ability to help patients overcome barriers to connection and encounter.