Rediscovering Psychopathology: The Epistemology and Phenomenology of the Psychiatric Object

Abstract

Questions concerning both the ontology and epistemology of the “psychiatric object” (symptoms and signs) should be at the forefront of current concerns of psychiatry as a clinical neuroscience. We argue that neglect of these issues is a crucial source of the stagnation of psychiatric research. In honor of the centenary of Karl Jaspers’ book, General Psychopathology, we offer a critique of the contemporary “operationalist” epistemology, a critique that is consistent with Jaspers’ views. Symptoms and signs cannot be properly understood or identified apart from an appreciation of the nature of consciousness or subjectivity, which in turn cannot be treated as a collection of thing-like, mutually independent objects, accessible to context-free, “atheoretical” definitions or unproblematic forms of measurement (as is often assumed in structured interviewing). Adequate and faithful distinctions in the phenomenal or experiential realm are therefore a fundamental prerequisite for classification, treatment, and research. This requires a multidisciplinary approach, incorporating (among other things) insights provided by psychology, phenomenological philosophy, and the philosophy of mind.

RDoC is necessary, but very oversold

“…For instance, there is insufficient research on the frequent and vexing problem of loss of clinical effects during long-term antidepressant treatment, including exploration of its neurobiological correlates, despite the practical implications that research in this area would entail (5). Another example is that antidepressant drugs have become increasingly popular as first-line treatment of anxiety disorders, despite lack of any evidence to support their superiority (6).…”

The importance of ternary awareness for overcoming the inadequacies of contemporary psychiatry

“…Even the originators of the check-list approach at Washington University had a more personcentered understanding of the process of psychiatric diagnosis than was implemented in DSM in 1980 27 . Human subjectivity cannot be adequately deconstructed into a collection of mutually independent objects that are free of context within the subjective consciousness of a person, as is usually assumed in a "Chinese-menu" approach to diagnosis and structured interviewing 28,29 . Consequently, check-list medical diagnosis is a clear example of the anti-spiritual bias in contemporary psychiatry, as has been popularized in successive versions of DSM since 1980 to the present 30,31 .…”

“…Sadly, the operational approach in medicine incorporates a strong bias to view sick people as defective objects because it is based on the assumption that the signs and symptoms of illness can be deconstructed into context-free objects that are mutually independent 29 . Contemporary psychiatric patients frequently complain of the lack of empathy and compassion of psychiatrists who do not listen to them more than they must to be able to renew or change psychotropic prescriptions.…”

From Perception to Thought: A Phenomenological Approach to Hallucinatory Experience

“…However, crucial foundational aspects of psychiatric investigation, such as the nature and statute of psychiatric sign and symptoms, 6 remain largely unaddressed. This is particularly evident in the case of the definition of hallucinatory experiences, allegedly a prototype of psychotic mental states.…”