Philosophy, Psychiatry, & Psychology

Professor Hadreas begins his interesting and challenging essay by saying that, "This paper is concerned with a model of self-awareness which fits the testimony of subjects' reactions to selective serotonin reuptake inhibitors (SSRIs), of which fluoxetine (Prozac, Lilly, Indianapolis, IN) is probably the best known" (2010, 43). Several important features of Dr. Hadreas' approach can be inferred from this statement. Most important, the verbatim testimony of subjects regarding their states of self-awareness is analyzed and interpreted for its compatibility with three philosophical models of self-awareness: Empiricism, rationalism, and Husserlian phenomenology. This is the methodology through which the author aims to show that one of the three models is more adequate than the others as a model of the self-awareness of the subjects, and that model is that of Husserlian phenomenology (hereinafter, phenomenology, with the understanding that only phenomenology according to Husserl is intended by both Dr. Hadreas and myself). In formulating this as the aim of his paper and his research, Dr. Hadreas has taken on an extremely difficult task.

In general, attempts to show that any philosophical stance bears directly and immediately on the understanding of patients' symptoms, as well as on both theoretical and therapeutic work with people with mental disorders, is, owing to the ostensible gap in levels of conceptualization and systematicity, that is, the theory/praxis divide ostensibly separating the two realms, extraordinarily difficult. The task is rendered even more difficult in work like that of Prof. Hadreas,' in which, I believe, the researcher does not want to "apply" philosophy parasitically, as if research into psychiatric phenomena in relation to philosophy is just a matter of cannibalizing philosophy for self-justification, or vice versa; rather, Hadreas wants to preserve the integrity of both research into the phenomenology of psychiatric disorders and of [End Page 53] the philosophical perspective that may improve understanding of those disorders. In undertaking an effort along these lines, Hadreas breaks new ground.

In particular, for this commentator, bringing Husserlian phenomenology to bear on these issues is particularly gratifying. Moreover, and most important, Hadreas bases his critique of classical empiricist and rationalist models of self-awareness on bringing to the fore Husserl's views on pre-reflective consciousness. This is extremely important for, as Dan Zahavi, noted Husserlian phenomenologist and philosopher of the phenomenology–psychiatry interface, points out, not only in the book cited by Hadreas but in a more recent article (Zahavi 2003), Husserl's notion of self-awareness has been critiqued by many who claim that he lacked a notion of pre-reflective consciousness. Indeed, Zahavi's (2003) work in this area quite effectively refutes these claims, and he does so by drawing on a large body of evidence from Husserl's posthumous writings. Thus, Hadreas is to be congratulated for using Husserl's long-neglected notion of pre-reflective consciousness as a means of approaching phenomenologically the testimony of patients who discussed changes in their self-awareness owing to their experiences with SSRI medications, chiefly fluoxetine. However, it is just because I share with Hadreas the conviction that Husserlian phenomenology is the best philosophical approach to understanding, and indeed, possibly improving the treatment of mental disorders, that I think it is vital to raise some questions regarding Hadreas' approach.

My first critical comment is this: Hadreas' aim in writing his paper is unclear in a way that calls his project into question. In the conclusion of his paper, he indicates that his findings can enable psychiatrists to determine which patients are more likely to experience "SSRI cures." Given this, it would seem that his purpose in introducing Husserlian phenomenology is to facilitate this goal. Those subjects, he finds (based on his phenomenological analysis of the subjects' own testimony), who "have lived enough of life to have formed, for better or worse, an abiding empirical ego" are more likely to be "good responders" to SSRIs. It would seem, then, that this finding would aid psychiatrists in evaluating patients who have been treated, or who might be treated, with SSRIs. This, then, if correct, would be a considerable...