Phenomenology and the interpretation of psychopathological experience


What do psychiatrists encounter when they encounter psychopathological experience in their patients? How should we interpret such experiences? In this chapter, we contrast a checklist approach to diagnosis, which is standard today and which treats psychiatric symptoms and signs (i.e., "the psychiatric object", Marková & Berrios, 2009; see also Chapter 2, this volume) as readily operationalizable object-like entities, with a nonstandard phenomenological approach that emphasizes the importance of a specific kind of interpretive interview. The descriptive methods of today’s psychiatry perpetuate what has been called psychiatry’s "problem of description" (Spitzer, 1988) because these methods are not adequately tailored to the ontological nature of the "psychiatric object." The psychiatric object is typically portrayed as an objective, thinglike entity, unproblematically graspable as it exists "in itself" through a behaviorist third-person perspective and as being indicative of a specific and modular physiological dysfunction. We will propose a different epistemological approach, considering the nature of mental disorders to be primarily constituted by the patient’s anomalies of experience, expression, and existence that typically involve suffering and dysfunction (Parnas, Sass, & Zahavi, 2013). Introduction: Is There a Problem in Contemporary Psychiatry?. More than thirty years ago, psychiatry, attempting to match somatic medicine in its scientific-biological foundations, underwent an "operational revolution," introducing criteria-based diagnoses and "operational definitions" of such criteria (American Psychiatric Association [APA], 1980). The operational project radically abridged, simplified, and condensed the then existing corpus of clinical knowledge into diagnostic manuals accessible to the grand publique because they are written in lay language and stripped of theoretical and psychopathological reflection. These manuals have long been the main source of clinical knowledge for psychiatrists in training (Andreasen, 2007). Moreover, it is assumed that a structured interview, that is, an interview in which a psychiatrist asks the patient a series of preformulated questions in a fixed sequence, is an adequate methodology for obtaining psychodiagnostic information. We will argue that this is a mistaken assumption.

Publication Title

Re-Visioning Psychiatry