Obsessive-compulsive symptoms and endogenous psychoses

Abstract

The nonspecific nature of obsessive-compulsive symptoms (OCSs) has been recognized since the era of classical psychopathology, whether due to their presence during the course of endogenous psychoses or their episodic/chronic manifestation in severe non-psychotic disorders. Adopting a phenomenological-dialectical perspective, this study aims to highlight the structural significance of OCSs within the context of endogenous psychoses, limiting the scope to clinical-psychopathological observations. Initially, the relationship between OCSs and manic-depressive illness is discussed. In melancholia, temporal retroversion and the objectification of time foster the emergence of obsessive phenomena; conversely, in mania, the expansion of the "Self" pole dissolves the obsessive impasse, pointing to opposing structural relationships. Next, schizophrenia is examined through the classic case of Lola Voss (Binswanger). Lola develops complex superstitions, a "compulsion to read," and a "phobia of clothing," eventually progressing to persecutory delusions. Binswanger questions whether delusional ideas can emerge from obsessive ideas or if both are expressions of the same "Delusional Mood." In this case, obsession and delusion intertwine, forming "graded shades of psychic structures." A diachronic analysis of the case allows for bridging classical clinical practice with contemporary research—such as the study by Egea-Fernandez et al. (2024), which identifies two phases of OCSs in patients taking clozapine: a first phase correlated with psychotic severity, and a second linked to the drug's serum concentration. The first phase finds a parallel in the Lola case, while the second prompts investigations into "body memory" and corporeality as dimensions involved in antipsychotic action. It is concluded that the integration of a phenomenological reading with contemporary empirical data broadens the understanding of SOCs in endogenous psychoses, shifting the focus from isolated symptoms to phenomena rooted in the totality of the psychopathological experience, and enabling an examination of the interface between diagnosis, structure, and therapeutic intervention.