Towards a Phenomenology of Self-Patterns in Psychopathological Diagnosis and Therapy

Abstract

Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories has without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions.

Pattern theory of self and situating moral aspects: the need to include authenticity, autonomy and responsibility in understanding the effects of deep brain stimulation

“…This case is a clear empirical manifestation of PTS's crucial theoretical claim that what constitutes the self "is a pattern, a dynamical gestalt, and what is important is the connectivity and the dynamical relations of the self-aspects" (Daly & Gallagher, 2019). In the case of Patient 4, impulsivity (affective aspects) and decreased conscientiousness, that is, carelessness (cognitive aspects, specifically personality traits) manifested by his erratic behavior (behavioral aspects) has consequences for intersubjective and normative as well as narrative aspects-the family of the patient does not recognize him as the same person they knew before DBS, as he acknowledged in his selfnarrative.…”

“…According to PTS, there is no metaphysically independent "thing-like" self to be found outside of the dynamically interrelated aspects arranged in the self-pattern; rather, "selves operate as complex systems that emerge from dynamical interactions of constituent elements. The dynamical relations or interactions among the various factors are important for defining the pattern as a dynamical gestalt that can change over time" (Daly & Gallagher, 2019). It is also worth emphasizing in the context of further considerations that these elements or aspects may have different weights in defining features of the self-pattern.…”

“…What must be emphasized, and is of crucial importance in the context of the relationship between PTS, authenticity, autonomy, and responsibility, is that narrative aspects play a crucial, dual role in this regard. First, narrative does not differ from any other aspect of PTS, in that a change in narrative may recursively induce a change in other aspects (and vice versa), and, consequently in the self-pattern, "since any change in any of the elements of the self-pattern may have an effect on the pattern as a whole" (Daly & Gallagher, 2019). Second, however, unlike the other aspects, narrative is reflective of other elements of the self-pattern.…”

“…In effect, narrative is a window allowing investigation of the details of the self-pattern, in both the first and third person-"this is the role of narrative that allows for its formalization in the second-person phenomenological interview" (Daly & Gallagher, 2019). Daly and Gallagher (2019) argue that the use of narrative in therapeutic contexts, such as in phenomenological interviews, is second-personal or intersubjective "in the sense that much of what the patient discovers and expresses in her narrative emerges only in the expression of it to the other person, the interviewer-physician, who is attempting to understand. In such cases, we can say that the processes that lead to these detailed descriptions or narratives are not private mental procedures, but intersubjective, interactive accomplishments."…”

“…Arguably, if disruptions of some of these aspects were above some threshold, inauthenticity could occur. In this regard, inauthenticity (and DBSinduced disruptions in other moral aspects of the self, autonomy and responsibility) can be similar to psychological disorders such as schizophrenia or depressionpsychological disorder may be diagnosed only when sufficiently many aspects of the self-pattern characteristic of a given disease change above certain threshold (see Daly & Gallagher, 2019).…”