Phenomenology and Dimensional Approaches to Psychiatric Research and Classification
Philosophy, Psychiatry, & Psychology
The classification of mental illness—enshrined in the Diagnostic and Statistical Manual of Mental Disorders (DSM)—has historically followed a categorial model of disorder. However, in light of psychiatry’s failure to validate the DSM categories, psychiatrists have developed dimensional models for understanding and classifying disorders, such as the National Institute of Mental Health’s Research Domain Criteria initiative (RDoC). While some philosophers have recently contributed to the literature on dimensional approaches to psychiatric research and classification, no sustained engagement has yet been offered by continental phenomenologists. In this article, I argue that phenomenological research can benefit from a broadly dimensional orientation—albeit one that differs in many respects from the RDoC. Developing this argument, I motivate, outline, and illustrate a phenomenological-dimensional approach. In so doing, I show how a dimensional orientation can circumvent problems stemming from the use of current diagnostic categories as a guide to psychiatric research. In addition, I argue that a dimensional orientation need not conflict with more traditional phenomenological approaches, such as the core gestalt model, and can even complement and support such approaches.
The Phenomenology of Psychopathological Embodiment: A Critique of Thomas Fuchs' Concept of Corporealization
Journal of Consciousness Studies
In this article I offer a critical analysis and evaluation of Thomas Fuchs' concept of corporealization, as well as the Leib/Körper distinction (i.e. the distinction between the lived and corporeal body) that it is founded upon. First, I show that the foundational concepts -- Leib and Körper -- are problematically heterogeneous, each including a diverse set of phenomena requiring further delineation and clarification. Second, I consider the historical origins of this heterogeneity and ambiguity within Fuchs' work. I show that Fuchs' Leib/Körper distinction, while owing more to Plessner than Merleau-Ponty, is to a great extent his own development. Third, I delineate five senses of the body, or of embodiment. These senses of the body are meant to (1) clarify the diverse phenomena included under Fuchs' label of corporealization and (2) offer examples of features of embodiment that challenge Fuchs' Leib/Körper polarity. Fourth, I argue that the concepts of Leib, Körper, and corporealization will need to be more rigorously defined before they can adequately illuminate the phenomena to which they are applied.
Depression as Existential Feeling or De-Situatedness? Distinguishing Structure from Mode in Psychopathology
Phenomenology and the Cognitive Sciences
In this paper I offer an alternative phenomenological account of depression, consisting of a degradation of the degree to which one is situated in and attuned to the world. This account contrasts with recent accounts of depression offered by Matthew Ratcliffe and others. Ratcliffe develops an account in which depression is understood in terms of deep moods, or existential feelings, such as guilt or hopelessness. Such moods are capable of limiting the kinds of significance and meaning that one can come across in the world. I argue that Ratcliffe’s account is unnecessarily constrained, making sense of the experience of depression by appealing only to changes in the mode of human existence. Drawing on Merleau-Ponty’s critique of traditional transcendental phenomenology, I show that many cases of severe psychiatric disorders are best understood as changes in the very structure of human existence, rather than changes in the mode of human existence. Working in this vein, I argue that we can make better sense of many first-person reports of the experience of depression by appealing to a loss or degradation of the degree to which one is situated in and attuned to the world, rather than attempting to make sense of depression as a particular mode of being situated and attuned. Finally, I argue that drawing distinctions between disorders of structure and mode will allow us to improve upon the currently heterogeneous categories of disorder offered in the DSM-5.
Language, Prejudice, and the Aims of Hermeneutic Phenomenology: Terminological Reflections on “Mania”
Journal of Psychopathology In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research.
The Subject Matter of Phenomenological Research: Existentials, Modes, and Prejudices
In this essay I address the question, “What is the subject matter of phenomenological research?” I argue that in spite of the increasing popularity of phenomenology, the answers to this question have been brief and cursory. As a result, contemporary phenomenologists lack a clear framework within which to articulate the aims and results of their research, and cannot easily engage each other in constructive and critical discourse. Examining the literature on phenomenology’s identity, I show how the question of phenomenology’s subject matter has been systematically neglected. It has been overshadowed by an unending concern with phenomenology’s methodological identity. However, an examination of recent contributions to this literature reveals that a concern with articulating phenomenology’s subject matter has gradually increased, although such articulations remain preliminary. In light of this, I delineate, define, and illustrate three layers of phenomenological research, which I term “existentials,” “modes,” and “prejudices.” While the delineation of these layers is drawn primarily from classical phenomenological texts, they are defined and illustrated through the use of more contemporary literature. Following the articulation of this subject matter, I briefly consider some of the debates—both foundational and applied—that can be facilitated by the adoption of this framework.
Contaminating the Transcendental: Toward a Phenomenological Naturalism
Journal of Speculative Philosophy
The proper relationship between phenomenology and naturalism has reemerged as a pressing issue following interdisciplinary developments in the cognitive sciences. Most solutions opt for a naturalized phenomenology, rather than a phenomenological naturalism. This article takes up the latter approach, confronting the implications of Merleau-Ponty’s reformulation of Husserl’s paradox of subjectivity. I argue that Merleau-Ponty’s formulation—which I term “the paradox of madness”—reveals a deep, ontological contingency in what Husserl took to be necessary transcendental structures of consciousness and world, revealing that these transcendental structures are in fact embedded in and contaminated by the very world they constitute and disclose.
Values-Based Practice and Phenomenological Psychopathology: Implications of Existential Changes in Depression (With Sarah Wieten)
Journal of Evaluation in Clinical Practice
Values-based practice (VBP), developed as a partner theory to evidence-based medicine (EBM), takes into explicit consideration patients’ and clinicians’ values, preferences, concerns and expectations during the clinical encounter in order to make decisions about proper interventions. VBP takes seriously the importance of life narratives, as well as how such narratives fundamentally shape patients’ and clinicians’ values. It also helps to explain difficulties in the clinical encounter as conflicts of values. While we believe that VBP adds an important dimension to the clinician’s reasoning and decision-making procedures, we argue that it ignores the degree to which values can shift and change, especially in the case of psychiatric disorders. VBP does this in three respects. First, it does not appropriately engage with the fact that a person’s values can change dramatically in light of major life events. Second, it does not acknowledge certain changes in the way people value, or in their modes of valuing, that occur in cases of severe psychiatric disorder. And third, it does not acknowledge the fact that certain disorders can even alter the degree to which one is capable of valuing anything at all. We believe that ignoring such changes limits the degree to which VBP can be effectively applied to clinical treatment and care. We conclude by considering a number of possible remedies to this issue, including the use of proxies and written statements of value generated through interviews and discussions between patient and clinician.
Reconsidering the Affective Dimension of Depression and Mania: Towards a Phenomenological Dissolution of the Paradox of Mixed States
Journal of Psychopathology In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attuned to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state.