The Grammar of the Psychiatric Interview

Stanghellini, Giovanni

doi:10.1159/000098486

Cited by 58 publications

(29 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This perspective recognizes that the clinician is not a neutral observer of the object, because he or she is part of an intersubjective field. The diagnostic encounter is indeed a second-person process [17,34,35], in which the clinician first grasps, through a personal involvement in the interaction, the ‘Gestalt', the wholeness of the clinical picture, and then he or she organizes the symptoms and signs in meaningful entities. Such a gestaltic comprehension of the patient's situation starts indeed from the initial pre-reflective feeling towards the presence of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Some scholars have pointed out that subjectivity and intersubjectivity, basic categories of the structure of human being-in-the-world, remain intrinsic aspects of thorough psychiatric assessment [34,35]. Furthermore, they underscored the necessity of complementing the third-person approach to psychiatric assessment, diagnosis and classification with first- and second-person approaches rooted in phenomenology and hermeneutics, respectively [35].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Pallagrosi

Fonzi²,

Picardi³

et al. 2016

Psychopathology

View full text Add to dashboard Cite

Background: Classical psychopathology greatly valued the interaction between clinician and patient, and assigned to the clinician's subjective experience a significant role in the diagnostic process. Psychoanalysis, too, ascribed a privileged position to the clinician's feelings and empathic participation in the assessment and deep understanding of the patient. This study aimed at testing the traditional, though still relatively unexplored empirically, tenet that particular diagnostic groups elicit distinct and diagnostically useful reactions from clinicians. Sampling and Methods: The study was performed in several psychiatric inpatient and outpatient units in Rome, Italy. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire and other standardized assessment instruments when they evaluated a previously unknown patient. All adult patients diagnosed with schizophrenia (n = 119), cluster B personality disorder (n = 114), manic or mixed bipolar I episode (n = 59), and unipolar depression or anxiety disorder (n = 130) were included in the study, for a total of 422 patients evaluated by 35 clinicians. Results: We found a significant and theoretically consistent relationship between the clinicians' pattern of subjective experience during the first visit and patients' clinical diagnoses. Patients with unipolar depression/anxiety showed significantly lower scores than the other groups on all ACSE scales except engagement; patients with schizophrenia displayed significantly higher scores than the other groups on difficulty in attunement, and significantly higher scores than patients with cluster B personality disorder on impotence. Compared with the other groups, the patients with cluster B personality disorder displayed significantly lower scores on engagement, and significantly higher scores on disconfirmation. In multivariate models controlling for patient's age and education, symptom severity, clinician's sex, duration of visit and setting, diagnosis remained a significant predictor of scores on all ACSE scales except for impotence. Conclusions: The main limitations of the study are its reliance on clinical diagnoses and the non-independence of assessments. Further studies based on diagnoses made by a third observer through standardized instruments are needed to provide a most stringent test of the hypothesis that different diagnoses are associated with distinct profiles of clinicians' subjective experience. This study provided intriguing, though preliminary, evidence that the clinician's subjective experience may play a useful role in the diagnostic process. Time may have come to reintroduce the concept of intersubjectivity at the core of the diagnostic process.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Pallagrosi

Fonzi²,

Picardi³

et al. 2016

Psychopathology

View full text Add to dashboard Cite

show abstract

“…[26][27][28][29][30] One way of understanding this problem is that it is about the relationship between mental states and behavior: Are mental states to be considered only as objects of scientific study-to be described and categorized-or is knowledge of mental states useful because they make a difference to what happens in the patient and in the clinician-patient relationship? The view that mental states made no difference to behavior was part of the reductionist world view that came to be known as epiphenomenalism.…”

Section: Phenomenological and Cognitive Paradigms: Meanings As Causes?mentioning

confidence: 99%

Person-Centered Psychopathology of Schizophrenia: Building on Karl Jaspers' Understanding of Patient's Attitude Toward His Illness

Stanghellini

Bolton

Fulford

2013

Schizophrenia Bulletin

View full text Add to dashboard Cite

In this article, building on and extending Jaspers' concept of the "patient's attitude toward his illness" we draw attention to the active role that the person, as a self-interpreting agent engaged in a world shared with other persons, has in interacting with his/her basic disorder and in the shaping of psychopathological syndromes. This person-centered approach helps us to see patients as meaning-making entities rather than passive individuals and their attempt at self-understanding as not necessarily pathological and potentially adaptive. We describe 3 contemporary resources for a person-centered psychopathology: dialectical psychopathology, contemporary approaches to the meanings-causes debate, and value-based practice. Each of these provides a theoretical framework and practical resources for understanding the diversity of schizophrenic phenotypes, including symptom presentation, course, and outcome as a consequence of the different ways people with schizophrenia seek to make sense of the basic changes in self and world experiences. A person-centered approach, in building on patients' individual values and experiences as key aspects of their selfunderstanding of their psychosis, supports recovery and development of self-management skills.

show abstract

“…Whereas nonconative empathy mainly involves the implicit resonance between my and the other's lived body as a means of understanding, conative empathy [19] requires something more than a resonating body: it puts into play my personal past experiences and my personal knowledge of commonly shared experiences (common sense). Conative empathy is, then, a more cognitive and reflective task than nonconative empathy as conceived in phenomenology.…”

Section: The Limits Of Empathymentioning

confidence: 99%

Empathy as a Sense of Autonomy

Stanghellini

Rosfort

2013

Psychopathology

Self Cite

View full text Add to dashboard Cite

In this paper, we examine Jaspers' ambiguous approach to empathy. We start by situating Jaspers' notion of empathic understanding in the context of contemporary philosophical discussions of empathy. We distinguish a phenomenological approach to interpersonal understanding from two influential accounts of other minds, namely, theory-theory and simulation-theory, and then we contrast Jaspers' notion of empathic understanding with a phenomenological approach. We distinguish two basic kinds of empathy, a prereflective nonconative kind and a more reflective conative kind. Then we argue that Jaspers' philosophical conception of human nature as restless and undefinable autonomy makes him reject any kind of comprehensive attempt to understand other people. We try to make sense of this rejection by discussing the epistemological and ethical nature of his notorious ‘theorem of incomprehensibility'. This eventually leads us, by way of conclusion, to sketch a method required for making sense of those experiences that cannot be understood via ordinary empathy. The key notion of this method is called ‘second-order empathy'.

show abstract

The Grammar of the Psychiatric Interview

Cited by 58 publications

References 42 publications

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Person-Centered Psychopathology of Schizophrenia: Building on Karl Jaspers' Understanding of Patient's Attitude Toward His Illness

Empathy as a Sense of Autonomy

Contact Info

Product

Resources

About