J Korean Neuropsychiatr Assoc.  2013 Sep;52(5):279-291.

Understanding of "Attunement Disorder" from Phenomenological-Anthropological Perspective : Inquiry into the Use of the Term "Attunement" in Psychiatric Literature

• Jeong SH
• Son JW
• Kim YS

Abstract

The Korean Neuropsychiatric Association has decided that the existing nomenclature "Schizophrenia" should be replaced with "Attunement disorder" in order to mitigate prejudices from the general public. In this process, "attunement" was meant to express the harmonious relationship and organic integration among the various substructures of global mental functioning. However, the term "attunement" and related concepts had occupied an important position in discourses surrounding the fundamental concept of schizophrenia. In this regard, the historical vicissitudes of the term "attunement" in the context of schizophrenia research was discussed. The term "attunement" is an English translation of Heideggerian expressions "Befindlichkeit" and "Stimmung". It is used by Heidegger to convey the emotional experience of Dasein's inextricable entanglement with the surrounding interpersonal world. Heidegger's philosophical works formed the theoretical foundation for the so-called Phenomenological-anthropological psychiatry. Psychiatrists influenced by this approach argue that patients with schizophrenia suffer from a sense of alienation and bewilderment resulting from loss of normal attunement. In addition, they stress that the loss of attunement brings about distorted self-experience, which leads to strange and uncanny life experiences exiled from intersubjectivity based society. From the phenomenological perspective, mind or consciousness is not a solipsistic Cartesian reason confined to the brain, but an intentional existence embedded in the interpersonal and intersubjective worlds. In the developmental period, intentional relationship between the consciousness and the world has been acquired from repeated shared experiences with other people via intersubjectivity. The intersubjective experiences also contribute to maintenance of solid attunement even after reaching mature adulthood. Whatever the reason, losing the tacit understanding of the world will cause disintegration of the foundation of intersubjectivity and confusion with regard to the certainties of self and the world. This state was described as "Attunement disorder". Recent emphasis on neurobiological understanding of schizophrenia has impeded the proper appreciation of Phenomenological-anthropological understanding of schizophrenia, one of the valuable heritages of psychiatry. Meanwhile, the concept of phenomenological understanding or embedded cognition has recently gained renewed attention among neuroscientists studying neurobiological correlates of consciousness. Standing on the pivotal point witnessing the conceptual change from "Schizophrenia" to "Attunement disorder", reappraisal of the past heritage from modern perspectives would be a valuable endeavor for advancement of psychiatry.

Keyword

Schizophrenia; Attunement; Phenomenology; Self; Intersubjectivity

MeSH Terms

Brain
Cognition
Consciousness
Emigrants and Immigrants
Humans
Life Change Events
Prejudice
Psychiatry
Schizophrenia

Figure

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  Fig. 1 Relationship between a subject and the world via (A) language and (B) extended language. Extended language denotes socially agreed-upon gestures, customs, conventions, laws etc. Subjects participate in the acquisition, creation and use of language and extended language based on intersubjectivity.

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  Fig. 2 A simplified overview of the development process of the concept "Attunement" in psychiatric literature. Boxes in gray color depict the concepts directly related to "Attunement" and those in white depict the concepts indirectly related to "Attunement".

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