The Dialectics of Altered Experience: How to Validly Construct a Phenomenologically Based Diagnosis in Psychiatry

Abstract

In this paper, we present how a dialectical perspective on phenomenological psychopathology, called Dialectical Phenomenology (DPh), can contribute to current needs of psychiatric diagnosis. We propose a three-stage diagnostic methodology: first- and second-person stages, and synthetic hermeneutics stage. The first two stages are divided into a pre-dialectical and a dialectical phase. The diagnostic process progresses in a trajectory of increasing complexity, in which knowledge obtained at one level is dialectically absorbed and intertwined into the next levels. Throughout the article, we offer some examples of each step. In overall, the method starts off from the patient's own narrative, proceeds to two stages of phenomenological reduction designed to guarantee the scientific validity of the object, and concludes with a hermeneutical narrative synthesis that is dialectically composed of the patient's and psychopathologist's shared narratives. At the end of this process, the initial first-person narrative is transformed into a specific scientific object, a full dialectical phenomenological psychiatric diagnosis. This form of diagnosis constitutes a comprehensive alternative for an integral assessment of the complexities of human psychological alteration, bringing together both the interpretation of the suffering person and the scientific categories of psychiatry.

Toward a Phenomenological Assessment of Values in Alcohol Misuse

“…The data analysis was based on the DPh, steps of which are detailed in Messas et al [17]. This method is based on a hermeneutic elaboration developed by the researcher (second-person perspective) over the subjective first-person account offered by the interviewee in a semi-structured interview, constituting a synthesis between first- and second-person perspectives.…”

“…Phenomenology has been considered one of the most relevant methods for carrying out this kind of study, both as a general investigation of altered experiences [14] and as a form of assessment of personal values in disorders like schizophrenia [9] or substance misuse [15], offering new tools for clinical decision-making [16]. In this study, we would like to extend this new scientific trend to AUD, through a dialectical phenomenological method (DPh) [14, 15, 17]. The DPh enables the researcher to describe some ideal types of experiences – in our case, of value experiences.…”

Phenomenology yesterday, today, and tomorrow: a proposed phenomenological response to the double challenges of contemporary recovery-oriented person-centered mental health care

“…The structural version of phenomenology probes the experiential field beyond the first-person narrative, revealing the pre-reflexive (or transcendental) structures of abnormal experience. Such pre-reflexive structures, although by definition not accessible by the mere description of the first-person experiences, can be assessed both by a reflective endeavor of the experiencing person and/or by the second-person hermeneutic endeavors of an expert directly engaged with and attentive to the accounts of the individual’s life world ( Messas et al, 2022 ).…”

Notas epigramáticas sobre uma existência fóbico-digressiva

“…Consideramos que esse método é adequado, neste caso, para tal, pelo fato de que nossa análise está fundamentada de forma significativa em inferências tomadas do contato clínico e apenas secundariamente da experiência relatada em primeira pessoa de William. Existe, portanto, uma imprecisão hermenêutica entre o método epigramático e a análise psicopatológica convencional (Messas, 2022).…”

“…Cabe, então, ao psicopatólogo que se orienta por tal linha analisar essas estruturas e suas dialéticas (Messas, 2022) com a finalidade de apreender a essência de uma experiência, isto é, um modo típico de desproporção das condições de possibilidade (e.g., desproporção esquizoide, desproporção melancólica, desproporção obsessiva etc.). Neste caso, buscaremos expor aquilo que na relação clínica com William se mostra como uma desproporção ou experiência vivida tipicamente fóbica, diferenciando-a de outras desproporções típicas.…”