Im Folgenden seien mehrere Definitionen der Zwangserkrankung (Zwangsstörung) von unterschiedlichen Autoren zur eigenen Lektüre und Beurteilung aufgeführt:
Die m. E. sehr lohnende Beschäfitung mit den philosophischen Ausführungen Karl Jaspers benötigen etwas mehr Raum, da sie wegen der im Medizinbetrieb sonst eher ungewohnten Denktiefe und Sprache einiger einführender Zitate bedürfen. Wer sich lieber direkt moderneren (Kurz-) Definitionen zuwenden und sich rasch informieren möchte, sollte diese Ausführungen überspringen und direkt bei Tölle weiterlesen.
Jaspers (1973) zählte die „Zwangserscheinungen“ zu den „reflexiven Phänomenen“. Störungen dieser Art treten nach Jaspers dann auf,
„wenn die Mechanismen der Verwirklichung und des Einbaus der Reflexion in die Unmittelbarkeit nicht ihren natürlichen, uns in ihrem Geschehen zwar völlig undurchsichtigen Ablauf haben, der die gegenüber aller Reflektiertheit bleibende Selbstverständlichkeit, Harmlosigkeit, Fraglosigkeit unseres Lebens ist.“ (S. 109)
Mit anderen Worten, Zwangsphänomene“ treten nach Jaspers an der Stelle auf, wo das unmittelbare Seelenleben auf die (Selbst-)Reflexion trifft und durch dieses Zusammentreffen die natürliche Seelentätigkeit gestört wird:
„Ich bin nicht nur bewusst im Sinne inneren Erlebens sondern auf mich zurückgewendet (reflektiert) im Selbstbewusstsein. In der Reflexion weiss ich nicht nur von mir, sondern wirke auf mich: in mir geschieht nicht nur etwas, sondern ich beabsichtige, erwecke, gestalte in mir ein Geschehen. Ich kann in mich Wirklichkeit gleichsam hineinziehen, kann sie hervorrufen und sie führen.
Die Entwicklung des Menschen im Indivisuum und in der Geschichte ist nicht nur eine Verwandlung wie bei allem biologischen Geschehen, sondern eine innere Arbeit der Seele und des Geistes mit sich selbst, ein Sichhervortreiben in Gegensätzen und Umschlägen, in der Dialektik aller Gehalte.
Damit gibt es kein rein unmittelbares Seelenleben mehr. Mit dem Denken und dem Wollen beginnt die Reflexion und mit der Reflexion die durch sie vermittelte Veränderung allen unmittelbaren Erlebens. Wo aber die Unmittelbarkeit aufhört, allein bestimmend zu sein, da gibt es nicht nur Steigerung, Entfaltung, Gewinn neuer Dimensionen der Erfahrung, sondern auch eigentümliche neue Störungen…“ (S. 109)
Zum Zwang:
„Normalerweise lebt das Ich ungezwungen in den Wahrnehmungen, die es gerade macht, in der Angst, die es fühlt, in den Erinnerungen oder den Träumereien, denen es nachgeht; sei es, dass es sich ihnen ohne Wahl triebhaft hingibt, sei es, dass es willkürlich sich erwählt, worauf seine Aufmerksamkeit gerichtet sein soll, was es zum Gegenstand seiner Affekte machen will. Wenn nun das Ich in dieser Wahl nicht mehr der Herr ist, wenn es keinen Einfluss darauf hat, welchen Gegenstand es sich zum jeweiligen Bewusstseinsinhalt machen will, wenn vielmehr der Bewusstseinsinhalt auch gegen diesen Willen der augenblickliche Inhalt bleibt, so stellt sich das Ich diesem Inhalt, den es nicht verdrängen kann, aber verdrängen möchte, kämpfend gegenüber, und dieser Inhalt erhält den Charakter des psychischen Zwanges. Dies ist kein Zwang, wie etwa in dem Falle, dass ein plötzlich von aussen eintretendes Ereignis unsere Aufmerksamkeit auf sich zieht, sondern ein Zwang von innen. Der Mensch hat statt des normalen Lenkbewusstseins (Kurt Schneider) gegenüber der Folge der Inhalte, denen er sich zuwendet, vielmehr das Zwangsbewusstsein, sein Bewusstsein ihnen nicht entziehen zu können.
Wenn im triebhaften erleben bald diese, bald jene Aufmerksamkeitsrichtung, bald dies, bald jenes Begehren wach wird, so reden wir nicht vom psychischen Zwang. Daraus erhellt, dass nur auf der Stufe willkürlich geleiteten Seelenlebens überhaupt psychischer Zwang möglich ist. Nur sofern seelische Vorgänge ein Aktivitätserlebnis enthalten, können sie Zwangsvorgänge werden. Wo eine willkürliche Leitung, wo ein Wählen nicht stattfindet, wie bei Idioten und Kindern auf früher Entwicklungsstufe, gibt es daher keinen psychischen Zwang.
Da alle psychischen Vorgäne, sofern die Aufmerksamkeit vom Willen abhängig ist, mit dem Charakter des Zwanges auftreten können, hat man, wenn man diesen Charakter hervorheben wollte, fast allen gelegentlich den Vorsatz der Silbe Zwangs- gegeben…Die Grenze des möglichen Zwangs ist dort, wo die Grenze meines Willens ist..“ (S. 111f)
Zu den Zwangsvorstellungen, Zwangsimpulsen etc. im engeren Sinne:
„(Die) Tatsache, dass Angstvorstellungen, Impulse usw. erlebt werden können, an die das Individuum immer denken muss, während es von der Grundlosigkeit der Angst, derSinnlosigkeit des Impulses, der Unmöglichkeit des Gedankens völlig überzeugt ist, bezeichnet man im engeren und eigentlichen Sinne mit den Worten Zwangsvorstellungen, Zwangsimpulse etc. In einem engeren Sinne nennen wir also Zwangsvorgänge solche Vorgänge, gegen deren Dasein der Erlebende sich erstens wehrt, und deren Inhalt ihm zweitens grundlos, sinnlos, unverständlich oder relativ unverständlich ist.“ (S.112)
Jaspers unterscheidet zwei Gruppen von Zwangsvorgängen mit Untergruppen (S. 112):
- erste Gruppe: „Zwangsvorgänge (im weiteren Sinne), bei denen nur der Charakter des subjektiven Zwanges bei gleichgültigem Inhalt das auszeichnende Merkmal ist (formaler Denkzwang)“. Beispiel:
- „Dem Bewusstsien kann sich eine Vorstellung, ein Gedanke, eine Erinnerung, eine Frage immer wieder aufdrängen; das typische Beispiel ist das Verfolgtwerden von Melodien. Oder es können nicht bloss einzelne Inhalte, sondern Denkrichtungen sich aufdrängen, z.B. die Sucht, alles zu erzählen, die Namen zu buchstabieren, über unlösbare und törichte Probleme nachzudenken (Grübelsucht) usw.“
- zweite Gruppe: „Zwangsvorgänge (im engeren Sinne), bei denen als zweites Merkmal die Fremdheit des trotzdem meist stark gefühlsbetonten Inhalts hinzukommt“
- „Zwangsaffekte: als fremdartig empfundene, unmotiviert auftretende Gefühle, gegen die sich der Befallene ohne Erfolg wehrt.“
- „Geltungszwang, der Zwang, etwas für wahr zu halten, dessen Unmöglichkeit man zugleich einsieht.“
- Zwangsantriebe, als unsinnig, der eigenen Persönlichkeit widersprechend empfundene Triebregungen, z.B. das eigene Kind zu töten.“
Zur Welt der Zwangskranken:
„Der Zwangskranke wird verfolgt von Vorstellungen, die ihm nicht nur fremd, sondern unsinnig erscheinen, und denen er doch folgen muss, als ob sie wahr seien. Tut er es nicht, so befällt ihn grenzenlose Angst. der Kranke z.B. muss etwas tun, sonst stirbt eine Person oder es geschieht ein Unheil. Es ist als ob sein Tun und Denken magisch das Geschehen verhindere oder bewirke. Er baut seine Gedanken zu einem System von Bedeutungen, seine Handlungen zu einem System von Zeremonien und Riten aus. Aber jede Ausführung hinterlässt den Zweifel, ob er es auch richtig, auch vollständig macht. Der Zweifel zwingt ihn, von vorn anzufangen….
Die Welt der Zwangskranken hat…zwei Grundcharaktere. Sie ist die Verwandlung von allem in Bedrohung, Schrecken, Gestaltlosigkeit, Unreinheit, Verwesung und Tod. Sie ist dieses aber nur durch einen magischen Sinn, der der negativ werdende Gehalt des Zwangsphänomens als solchen ist: eine bezwingende, wenn auch als absurd begriffene Magie.“ (S. 240)
Tölle (1999):
„Zwang (Anankasmus, obsessiv-kompulsives Syndrom) liegt vor, wenn sich Denkinhalte oder Handlungsimpulse immer wieder aufdrängen und nicht unterdrückt oder verdrängt werden können, obwohl erkannt wird, dass sie unsinnig sind oder zum mindesten ohne Grund Denken und Handeln beherrschen. Wird diesem Drang nicht nachgegeben, so stellt sich unerträgliche Angst ein. Nicht die Inhalte des Zwanges sind das Pathologische, sondern ihr dominierender Charakter und die Unfähigkeit, sie zu verdrängen.“ (S. 97)
Deister (2001, S. 127ff):
- Zwangsgedanken:
- „Zwangsgedanken sind zwanghaft sich immer wieder aufdrängende, jedoch als unsinnig erkannte Denkinhalte.“
- Zwangsimpulse:
- „Handlungsimpulse, die sich zwanghaft gegen den Willen durchsetzen wollen, verbunden mit der Angst, eine Handlung könne ausgeführt werden (was aber gewöhnlich nicht geschieht).“
- Zwangshandlungen:
- Zwanghaft gegen oder ohne den Willen ausgeführte Handlungen. Beim Versuch, die Handlungen zu unterlassen, treten massive innere Anspannung und Angst auf.“
Faust (1995), der die „Zwangssyndrome“ zu den Angststörungen rechnet, definiert wie folgt:
„Zwangsphänomene sind aufgezwungene, persönlichkeitsfremde und willentlich nicht kontrollierbare Stereotypien. Sie können sich als Zwangsvorstellungen (obsessions) auf den kognitiven Bereich und als repititive, ritualisierte Verhaltensmuster (compulsions) auf den motorischen Bereich beschränken, werden jedoch zumeist gemeinsam angetroffen.“ (S. 472f)
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