Emotions and personhood are important notions within the field of mental health care. How they are related is less evident. This book provides a framework for understanding the important and complex relationship between our emotional wellbeing and our sense of self, drawing on psychopathology, philosophy, and phenomenology.
How can we better understand and treat those suffering from schizophrenia and manic-depressive illnesses? This important new book takes us into the world of those suffering from such disorders. Using self descriptions, its emphasis is not on how mental health professionals view sufferers, but on how the patients themselves experience their disorder. A new volume in the International Perspectives in Philosophy and Psychiatry series, this book will be of great interest to all those working with sufferers from such disorders - (...) helping them to better understand their mental lives, and providing important insights into how best to treat them. (shrink)
This handbook is currently in development, with individual articles publishing online in advance of print publication. At this time, we cannot add information about unpublished articles in this handbook, however the table of contents will continue to grow as additional articles pass through the review process and are added to the site. Please note that the online publication date for this handbook is the date that the first article in the title was published online.
Currently, anomalous lived temporality is not included in the main diagnostic criteria or standard symptom checklists. In this article, we present the Transdiagnostic Assessment of Temporal Experience, a structured interview that can be used by researchers and clinicians without a comprehensive phenomenological background to explore abnormal time experiences in persons with abnormal mental conditions regardless of their diagnosis. When extensive data gathered by this scale are available, it will be possible to delineate well-defined anomalous lived temporality profiles for each psychopathological (...) disorder. This instrument may also prove useful for clinicians by providing a more refined assessment of relevant psychopathological symptoms and an in-depth understanding of the patient’s abnormal behaviour as related to specific types of time experience. In the first part of the article, we provide a brief overview of the phenomenological concept of temporality, including pre-phenomenal and phenomenal time, synthesis, conation and synchronization, and of abnormal time experiences in persons affected by psychopathological conditions. In the following part, we describe the basic structure of the interview that comprises seven categories corresponding to the abnormal features of lived temporality: anomalies of synchrony, of time structure, of implicit time flow, of explicit time flow, and anomalous experiences of the past, the present and the future. The paper also includes a section on administration and scoring of the TATE scale, the complete interview and a Likert table for quantifying the frequency, intensity and interference with daily life of the phenomena explored. (shrink)
Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences. However, too few practising psychiatrists are familiar with the literature in this area. -/- The Oxford Handbook of Philosophy and Psychiatry offers the most comprehensive reference resource for this area ever published. It assembles challenging and (...) insightful contributions from key philosophers and others to the interactive fields of philosophy and psychiatry. Each contributions is original, stimulating, thorough, and clearly and engagingly written - with no potentially significant philosophical stone left unturned. Broad in scope, the book includes coverage of several areas of philosophy, including philosophy of mind, science, and ethics. For philosophers and psychiatrists, The Oxford Handbook of Philosophy and Psychiatry is a landmark publication in the field - one that will be of value to both students and researchers in this rapidly growing area. (shrink)
2013 sees the centenary of Jaspers' foundation of psychopathology as a science with the publication of his magnum opus the Allgemeine Psychopathologie (General Psychopathology), Many of the issues concerning methodology and diagnosis are today the subject of much discussion and debate. This volume brings together leading psychiatrists and philosophers to discuss the impact of this volume, its relevance today, and the legacy it left.
We are glad to acknowledge the wide spectrum of topics posited by our commentators and at the same time the recognition of the thematic issue of our project: that the mentally ill is still a person, and that this humane dimension of his existence must be brought to the fore in psychopathological studies and kept always in the fore in the therapeutic process.We are also glad to have encountered appreciation for the fact that long gone is the time when the (...) clinician could have afforded to be the plenipotentiary in the therapeutic relationship, and that a more equal geometry of relations with the patient is not only useful but probably necessary for therapeutic success, intended as a "success [that] also involves... (shrink)
Persons with borderline personality disorder are often described as affected by extreme emotional fluctuations and by the sudden emergence of uncontrollable and disproportionate emotional reactions. Borderline persons frequently experience their own self as dim and fuzzy, are deprived of a stable sense of identity and unable to be steadily involved in a given life project. We will interpret these typical features as fluctuations between a clearly normative emotion such as anger and the more diffuse and confusing background of bad moods (...) like dysphoria. Our main focus will be on dysphoria. The intentional structure that characterizes much of human emotional experience, we shall argue, is absent in dysphoria. If we imagine emotions as fluxes of intentionality that innervate the body and connect it to the world, dysphoria is empty intentionality, so to speak, devoid of the moderating power of language and representation. Dysphoria exerts a centrifugal force which fragments the borderline person's representations of herself and of others, inducing a painful experience of incoherence and inner emptiness, a feeling of uncertainty and inauthenticity in interpersonal relationships, and an excruciating sense of futility and inanity of life. But it also entails a sense of vitality, although a disorganized, aimless, and explosive one -- a desperate vitality. (shrink)
In this paper, we consider the nature of two aspects of human emotional experience—moods and affects—in their relation to the concept of the person. We argue for the importance of the concept of the person in an approach to human emotional experience. This paper differentiates between the concepts of minimal self, extended self, and person. Furthermore, it offers a phenomenological proposal to understand the feeling dimension of moods and affects as critical for the differentiation of human emotional experience, and hence (...) an understanding of that experience. By way of conclusion, we opt for a narrative approach to the question of the normative dimension of emotional experience to clarify the intricate relationship between mood and personhood. (shrink)
The field of psychiatry has long struggled with developing models of practice; most underemphasize the interpersonal aspects of clinical practice. This essay is unique in putting intersubjectivity front and centre. It is an attempt to provide a clinical method to re-establish the fragile dialogue of the soul with oneself and with others.
To provide a qualitative analysis of abnormal temporal experiences of persons affected by feeding and eating disorders. This is a naturalistic explorative study on a group of 27 patients affected by FED interviewed over a two-year period in a clinical/psychotherapeutic setting. Clinical files were analysed by means of Consensual Qualitative Research. Twenty-one out of twenty-seven patients affected by FED reported at least one ATE. The main categories identified are 1) Irruption of disturbing bodily experiences ; 2) Anxiety for the passing (...) of time ; 3) Ritualization/Digitalization of time. ATE are a relevant feature of the life-world inhabited by people with FED and may represent an important link between abnormal bodily experiences and disorders of personal identity in these patients. The sample number is small but our preliminary findings justify testing a larger number of patients. (shrink)
Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. The series will aim to build links between the sciences and humanities in psychiatry. Our ability to decipher mental disorders depends to a unique extent on both the sciences and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', and the humanities provide insight into its 'meanings' and helps with our 'understanding'. Psychiatry, (...) if it is to develop as a balanced discipline, must draw on input from both of these spheres. Nature (for causes) and Narrative (for meanings) will help define the series as a whole by touching on a range of issues relevant to this 'border country'. With contributions from an international star-studded cast, representing the field of psychiatry, psychology and philosophy, this volume will set the scene for this new interdisciplinary field. This will be of interest to all those with practical experience of mental health issues, whether as providers or as users/consumers of services, as well as to philosophers, social scientists, and bioethicists. (shrink)
In lieu of an abstract, here is a brief excerpt of the content:From the Patient's Perspective:Engaging With the OtherGiovanni Stanghellini*, MD, DPhil Honoris Causa (bio)Homo homini salusOne century after the first conference gathering first-generation clinical phenomenologists in Zurich in 1922, today's psychiatry is far from exploring phenomena from the patient's perspective—that is, "letting-be" the Other, and "giving or compromising"—that is, engaging with the Other (Doerr-Zegers, 2022).The motto of phenomenology has been since its beginning "To things themselves!". Edmund Husserl—the founder of (...) phenomenology in the field of philosophy—exhorted to go back to the things themselves, that is, to render self-evident in fully fledged intuitions that what is usually given in preformed abstractions like "concepts," "judgments," "truths," and so on (Husserl, 1970).Clinical phenomenology has taken up Husserl's motto and added another: "To understand is to cure." Put together, the result is: "To cure is to understand the things themselves." But what does exactly mean "To the things themselves"? And what does it mean "to understand"? What is the use of understanding in the clinical setting? And, ultimately, what does the "cure" consist of?What Are the "Things Themselves" in PsychiatryIn the clinical setting, the "things themselves" (Stanghellini & Ikkos, in press) are the patients' own experiences, that is the patient's psychopathological world as experienced in the first person's perspective—what clinical phenomenology calls the "phenomena." Clinical phenomenology's very conception of the object of psychiatry, that is the patient's abnormal experiences lived in the first-person perspective and embedded in anomalous forms of consciousness and existential patterns, has been vastly oversimplified by current assessment procedures (Stanghellini, 2013). Today, there is a risk that clinical blinkering results in clinicians being only able to view the symptoms relevant to diagnosis and classification and excludes the scrutiny of the diverse and varied nature of what is really there in the patient's experience—the essential prerequisite to understanding his/her condition (Stanghellini & Broome, 2014). This oversimplification has been reinforced by reliance on techniques (e.g., an emphasis on behavioral symptoms and on reliability rather than validity) that are unable to capture the subtle distinctions [End Page 287] in experience that constitute the essentials of the "things themselves" in psychopathology, and to acknowledge that what the patient manifests is not a series of mutually independent, isolated symptoms, but rather certain meaning-structures of interwoven experiences, beliefs, and actions, all permeated by biographical details (Nordengaard & Parnas, 2013).The Problem of the Causes and Meanings of PhenomenaTo go to the "things themselves"—to "let them be"—we should acknowledge that to understand is neither to interpret nor to explain. It is not to interpret, i.e. to attribute a meaning, that is, to replace a manifest content, considered superficial and misleading, with a latent content, considered profound and authentic. Psychiatry as a branch of bio-medicine (as it is known) does not principally deal with meanings, but certainly not because it aims to the "things themselves." Psychiatry first and foremost deals with the causes of phenomena, that is, it tries to explain (scire per causas)—not to understand. The dream of psychiatry is to trace the causes of the symptoms to neutralize the symptoms in statu nascendi. Psychiatry is (would like to be) a science of the mechanisms leading to the formation of mental symptoms.Compared with the intentions of psychiatry, the intentions of psychological hermeneutics, which deals with revealing the meanings of phenomena, may seem a relief and progress, at least if seen from a "humanitarian" angle. The dream of psychology—or at least of certain psychology (such as that of psychoanalytic inspiration)—is to bring to light the authentic meaning of a symptom. Hermeneutic psychology, for example, a psychoanalytic one, is (would like to be) an archaeology of the symptom, unearthing its profound significance.I am not arguing against explanations and interpretations per se, rather underscoring the way these may stand in the way of engaging with the patient in a third mode of approaching clinical phenomena, that is understanding. Both psychiatry's attempts at explanation and hermeneutic psychology's attempts at interpretation may suffocate... (shrink)
A significant cluster of complaints of persons affected by schizophrenia, for example, their feeling ephemeral, lacking core identity, being affected by a diminished sense of existing as a self-present subject, point to the disruptions of structural aspects of the core self. These and similar disturbances aggregate significantly and selectively in the schizophrenia spectrum disorders, occur and are detectable in adolescents at risk of future schizophrenic disorder, and have a tendency to persist. All this led to the proposal that the generative (...) disorder in schizophrenia is a disorder of the self. The phenomenological notion of the self serves to investigate the fact that we live.. (shrink)
Philosophers have hitherto only interpreted the world in various ways; the point is to change it.Karl marx’s distinction between interpreting the world and changing it points by extension to the state of contemporary philosophy and psychiatry. The 1990s resurgence of interdisciplinary work in this area was driven equally by phenomenological scholarship and by initiatives in analytic philosophy. The former reflected the focus in phenomenology on ‘what it is like’ to experience a given mental symptom with the aim of reconstructing the (...) life-worlds of people experiencing mental disorders, while the latter reflected directly or indirectly the influence of J. L. Austin and others from... (shrink)
Traditional psychopathological approaches to modelling the evolution of mental disorders, such as schizophrenia, often rest on the assumption that symptoms are the passive expression of an underlying disease process. In contrast, phenomenological approaches have highlighted the role that the person, as a meaning-making agent undergoing basic anomalous experiences, plays in the construction of their worlds – thus partly shaping the manifestation and course of illness. However, it remains to be explored how specific patterns of interaction between the person and his/her (...) basic anomalous experiences unfold and play out. We appeal to the Husserlian notion of “position-taking” (Stellungnahme) to provide a framework for the investigation of the person’s attempts at healing as a fundamental component of the dialectics of symptom formation in the psychoses. Within this framework, psychotic symptoms are understood as the expression of the person’s efforts at making sense of, and adapting to, the existential challenges associated with the onset of anomalous self- and world-experiences. We draw on selected case studies and the testimony of one of the authors, to illustrate the potential clinical applications of this model. Finally, we outline some advantages of this approach, including its potential to address oft-neglected troubling experiences without threatening the person’s epistemic agency. (shrink)
Awareness of illness in schizophrenia reflects complex storied understanding of the impact of the disorder upon one’s life. Individuals may be aware of their illness in different ways and this may be related to their functioning. A total of 76 adults with schizophrenia were assessed for their awareness of illness, neurocognition, social cognition, and social function concurrently and social function was also assessed at three later time points. A cluster analysis revealed 3 groups: generally full awareness, generally limited awareness, and (...) superficial awareness. Comparisons between these profiles revealed the superficial group had poorer executive function, emotion recognition ability, and capacity for social relationships than the full awareness group, yet had better verbal memory and more social contacts than the limited awareness group. These results suggest assessing the narrative qualities of awareness of illness may reveal unique links with cognition and function, and this may have implications for interventions. (shrink)
This essay is unique in putting intersubjectivity front and center. It is an attempt to provide a clinical method to re-establish the fragile dialogue of the soul with oneself and with others. Throughout, the book builds on the assumption that to be human means to be in dialogue. It uses dialogue as a unitary concept to address three essential issues for clinical practice: 'What is a human being?', 'What is mental pathology'?, and 'What is care?'. To be human - it (...) is argued - means to be in dialogue with oneself and with other persons. Thus, mental pathology is the interruption of this dialogue - of the person with the alterity that inhabits them, and with the alterity incarnated in other persons. Therefore, therapy is a dialogue with a method whose aim is to re-enact one's interrupted dialogue with alterity. Lost in Dialogue provides a method to approximate the Other, to understand its experiences, actions, and in general, understand the world in which it lives. (shrink)
The psychiatric interview plays a critical role in clinical assessment and therapy. Problems with assessment reliability and validity that were apparent in nosological and diagnostic discrepancies plagued the field of psychiatry historically. Technical approaches including structured interviews were developed to address these problems. Although these approaches decreased diagnostic variance, they focused narrowly on eliciting signs and symptoms conforming to previously agreed diagnostic categories, necessarily restricting the range and richness of experiences and narratives that are elicited. This restriction inhibits the utility (...) of assessment in furthering the interpersonal rapport and exploration that is essential to the task of therapy. The author reviews critiques of technical approaches to psychiatric assessment and highlights critical, often unexamined, epistemological assumptions and questions. In light of these critiques, he proposes a phenomenological approach to psychiatric assessment focused on narratives that situate particular experiences in the broader life context. In this approach the assessor functions as a participant observer, relying on the same empathic skills that inform effective therapy. It is argued that without over turning the advances in assessment reliability gained through technical approaches to the psychiatric interview, a phenomenological approach can illuminate, enrich, and broaden psychiatric assessment, increasing its effectiveness in psychopathological understanding and in therapy. (shrink)
I develop here one of the many topics raised by Sass, Parnas, and Zahavi, namely the role of phenomenology in clarifying issues not amenable to standard empirical methods. The authors of this scholarly paper mainly tackle this issue from the angle of psychopathological research in schizophrenia. I would like to build on their argument, having in mind one dimension of clinical phenomenology that has not been approached in their paper: the issue of care, that is the use of the method (...) implemented by clinical phenomenology in the therapeutic setting.I first briefly outline some methodological principles of clinical phenomenology in the context of psychopathological research that may be implemented in the context of .. (shrink)
The purpose of this paper is to define and describe the main phenomenological dimensions of the life-world of persons prone to Feeding and Eating Disorders (FEDs), within the framework of a model that considers abnormal eating behaviour an epiphenomenon of a more profound disorder of lived corporeality and identity. The core idea is that persons with FEDs experience their own body first and foremost as an object being looked at by another, rather than coenaesthetically or from a first-person perspective. Alienation (...) from one’s own body and the need to feel oneself only through the gaze of the others can be illuminated by looking at it in the light of the Sartrean concept of feeling a lived-body-for-others. (shrink)
The psychopathological analysis of hysteria is a victim of narrow conceptualizations. Among these is the inscription of hysteria in the feminine sphere, about body and sexuality, which incentivized conceptual reductionism. Hysteria has been mainly considered a gendered pathology, almost exclusively female, and it has been associated with cultural and/or religious features over time rather than treated as a psychopathological world. Further, hysteria has been dominated by conceptual inaccuracies and indecision, not only in terms of clinical features but also in terms (...) of its definition. For this reason, it seems necessary to “undress” hysteria from this feminization, sexualization, and corporealization with which it has been abundantly clothed over the years. “Undressing” hysteria will make possible a reconfiguring and deconstructing of the explanatory-causal model of Charcot and Freud. However, if we take out this cultural heritage, the stigma accompanying this diagnosis, and the weight of the enormous historical tradition that hysteria carries, the world of hysteria continues to constitute a domain full of complexity and nosographic challenges. Hysteria has been considered a sum of psychological behaviors and states illustrated by drama, mystery, or falsity. The difficulty in understanding the multiple somatic manifestations which characterize this clinical condition created several controversies and much confusion. In the current nosography, the personological component of hysteria has been separated from its symptomatic manifestation, in the Histrionic Personality Disorder and Conversion Disorder categories, respectively. This segmentation by descriptive nosography does contribute to a unitary understanding of the phenomenon and, consequently, of daily clinical practice. Clinical complexity can be grasped and deciphered only if the symptom is inscribed in the patient’s lifeworld and his/her subjective life history. Clinical practice is thus thought of in terms of a structural aggregation of a homogeneous set of phenomena, together constituting a specific way of being in the world. The starting point of this article is the evident modalities characterizing this life-world, taking care not to confuse the point of origin with the point of expression. (shrink)
In a previous paper, we discussed a model that considers abnormal eating behaviour epiphenomena of a more profound disorder of lived corporeality and identity (Stanghellini and Mancini, this issue). The core idea is that persons with FEDs experience their own body first and foremost as an object being looked at by another, rather than coenaesthetically or from a first-person perspective. In this paper, alienation from one’s own emotions, disgust and shame for one’s body of persons with FED, will be discussed (...) in the light of the embodiment and identity model of FED. (shrink)
Three revolutions in psychiatry characterised the closing decade of the twentieth century: 1) in the neurosciences, 2) in patient-centred models of service delivery, and 3) in the emergence of a rapidly expanding new cross-disciplinary field of philosophy and psychiatry. Starting with a case history, the paper illustrates the impact of this third revolution - the new philosophy of psychiatry - on day-to-day clinical practice through training programmes and policy developments in what has become known as values-based practice. Derived from philosophical (...) value theory and phenomenology, values-based practice is a partner to evidence-based practice in supporting clinical decision-making in the highly complex environment of mental health care. The paper concludes by setting values-based practice in context with other potentially practical important areas of the new philosophy of psychiatry arguing that all three revolutions need to be brought together if psychiatry is to meet the challenges of the twenty-first century. (shrink)