The study of subjective experience as a scientific task for psychopathology

Abstract: The debate on the scientific validity of mental disorders and psychopathological phenomena is considered in the broader context of the paradigmatic crisis occurring in nowadays psychiatry. The author comments a work of Stoyanov, Machamer and Schaffner appeared on this journal. There is a complete agreement on two basic assertions: a) practically, clinical interviews, structured interviews based on the DSM and psychometric scales are different but overlapping instruments exploring the same phenomenal level; b) psychiatry is not a unitary science but a multifaceted activity based on different domains of knowledge. However, the related assumption that instruments exploring psychopathological phenomenology are not enough scientific because they are too much subjective is questioned. At the epistemological level, it is shown that subjectivity is everywhere since all scientific observations are theory-laden. Nevertheless, it is suggested that this state of affairs does not necessarily lead to methodological anarchism and is compatible with a scientific stance. At the psychopathological level, it is shown that both mental disorders and symptoms are hermeneutical constructions and that Jaspers introduced phenomenology as the proper scientific equipment for the scientific study of subjective experience. In conclusion it is suggested that psychopathological phenomenology can be renewed to meet the present-day scientific needs, but psychopathology cannot work without the awareness that its scientific descriptions are always based on a semiotic activity.
The entire article can be freely downloaded at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2011.01794.x/full

THE EPISTEMOLOGICAL BASIS OF PSYCHIATRIC CONTROVERSIES

D. Kecmanovic recently published a paper on the reasons of the endless psychiatric controversies. A debate followed. Among the others, M. Aragona focused on the epistemology of psychiatry. He reminds that “taken as a whole the disciplines concerned with the mind and with mental pathologies do not constitute a mature science. While the various branches of medicine are all subtended by a common basic science grounded on a unique and shared view of the human body functioning, the various disciplines studying the mental phenomena are based on different theoretical principles, see their field of study from different viewpoints, use different techniques of inquiry and presuppose interpretations and solutions which are widely heterogeneous” (Aragona M. Aspettando la rivoluzione. Editori Riuniti, Roma, 2006, p.34). However, the author notes that to define psychiatry as a pre-paradigmatic scientific activity risks to pass unnoticed a fundamental assumption. In fact, the implicit idea is that psychiatry should conform to this model and that its current position is that of an immature science that in the future will be based on a unique scientific paradigm. This process will let all the other perspectives on the matter to progressively disappear from the scientific debate, being reconceptualized as non-scientific or proto-scientific cultural forms. This is the faith accompanying from its beginning any somatological theory about mental illness but the risk is to covertly introduce here a reductionist assumption: there are many perspectives and many models only because psychiatry is not scientific yet. Is it a correct picture of psychiatry, or at the opposite the peculiar object of study of our discipline (the mental suffering of the human being) cannot in principle be fully reduced to the materialistic study of his brain? The plurality of models is a transient phenomenon, or the multi-perspectivist approach is intrinsic to psychiatry and thus unavoidable? The methodological pluralism of Karl Jaspers is used here to support a multiperspectivist stance. In conclusion, psychological perspectivism and pragmatism (intended as choosing this or that model depending on the relevance of specific scientific/clinical questions and on the most appropriate model to answer) are proposed. It is suggested that the basic epistemological tension underlying psychiatric controversuies is that between a realist model (that sounds scientific but is historically untenable) and a constructivist model which is better corroborated by the historical inquiry but that by acknowledging the unavoidable role of hermeneutics risks to be perceived as anti-scientific and radically relativistic.
The link to read this article and the entire debate is: http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol23_no3/dnb_vol23_no3_02.pdf

Dialogues in Philosophy, Mental and Neuro Sciences 2011; Vol.4, Issue 2

The new issue of Dialogues in Philosophy, Mental and Neuro Sciences is online. Two articles focus on phenomenological psychopathology.
In the first one, Maria Luísa Figueira and Luís Madeira (Lisbon University) discuss the role of time and space in the phenomenology of bipolar disorders, particularly in mania. Theories by Heidegger, Husserl and Merleau-Ponty as well as by Minkowsky, Binswanger, Fuchs, Parnas, and Sass are reviewed in relation to euphoric and dysphoric manic and hypomanic states.
This article can be freely downloaded at: http://www.crossingdialogues.com/Ms-A11-01.pdf
In the second paper, Paola Gaetano discusses a previous paper published on a past issue of Dial Phil Ment Neuro Sci (Kraus A. Existential a prioris and the phenomenology of schizophrenia). She argues that the current diagnostic systems have inadvertently resulted in an impoverished clinical practice; From their purely descriptive point of view schizophrenic symptoms that would appear bizarre and senseless. On the contrary, Gaetano suggests that there is substantial meaning underlying psychotic phenomena and that an Heideggerian conception of human existence (the existence is always 'in the world', 'near the things' and 'with the others' in the unity of the Dasein) may help understand the subjective experience of a schizophrenic patient and increase diagnostic accuracy and treatment adequacy. This article is at this link: http://www.crossingdialogues.com/Ms-A11-02.pdf
A third article (Mari Stenlund: Involuntary antipsychotic medication and freedom of thought) deals with a complex issue in applied ethics: what is the relationship between the use of involuntary antipsychotic medication and a delusional person's freedom of thought? The author shows that clinical practice strictly depends on the way we conceive freedom. Accordingly, she discuss different stances in the psychopharmacological approach in the light of three different views of freedom, namely, freedom as negative freedom, freedom as having an autonomous mind and freedom as capability. Download at: http://www.crossingdialogues.com/Ms-C11-02.pdf
Another paper discusses the classic antipsychiatric text of Thomas Szasz (The myth of mental illness) from a semiotic point of view. It is shown that Szasz’s revolution is to consider the hysterical symptoms as a foreign language, thus allowing a semiotic analysis. Accordingly, the somatic language of the hysteric person is discussed as an iconic protolanguage. The conclusion is that the hysterical symptom speaks its proper language and our ethical commitment is primarily to empathically listen to it (Valeria Lelli: The body language: a semiotic reading of Szasz' Anti-psychiatry). The link to read this contribution is: http://www.crossingdialogues.com/Ms-C11-03.pdf
Finally, Sofia Siwecka presents the epistemological ideas of a great figure in the early philosophy of medicine: Ludwik Fleck. Fleck anticipated many ideas later defended by the “new philosophy of science” (e.g. Thomas Kuhn) but is only rarely cited because his main contributions are in Polish. Siwecka directly translated Fleck’s texts and introduces the reader to his theory of knowledge. Applied to psychiatry, the ideas of Fleck shed light on how psychiatric diagnoses are influenced by a specific thought style that directs the observations and affects the development of knowledge and the formation of connections between concepts. This article is at: http://www.crossingdialogues.com/Ms-C11-04.pdf