Critical phenomenology and psychiatry

Whereas classical Critical Theory has tended to view phenomenology as inherently uncritical, the recent upsurge of what has become known as critical phenomenology has attempted to show that phenomenological concepts and methods can be used in critical analyses of social and political issues. A recent landmark publication, 50 Concepts for Critical Phenomenology, contains no reference to psychiatry and psychopathology, however. This is an unfortunate omission, since the tradition of phenomenological psychiatry—as we will demonstrate in the present article by surveying and discussing the contribution of Jaspers, Minkowski, Laing, Basaglia, and Fanon—from the outset has practiced critical thinking, be it at the theoretical, interpersonal, institutional, or political level. Fanon is today a recognized figure in critical phenomenology, even if his role in psychiatry might not yet have been appreciated as thoroughly as his anticolonial and antiracist contributions. But as we show, he is part of a long history of critical approaches in psychopathology and psychiatry, which has firm roots in the phenomenological tradition, and which keeps up its critical work today.

Nomothethic Network Psychiatry: A Bottom-Up Approach to Build Data-Driven Disease Models Based on Risk-Resilience, Adverse Outcome Pathways, and Phenome Scores, and to Discover New Biosignature-Based Classifications

Psychiatry remains in a permanent state of crisis, which fragmented psychiatry from the field of medicine. The crisis in psychiatry is evidenced by the many different competing approaches to psychiatric illness including psychodynamic, biological, molecular, pan-omics, precision, cognitive and phenomenological psychiatry, folk psychology, mind-brain dualism, descriptive psychopathology, and postpsychiatry. The current “gold standard” DSM/ICD taxonomies of mood disorders and schizophrenia are unreliable and preclude to employ a deductive reasoning approach. Therefore, it is not surprising that mood disorders and schizophrenia research was unable to revise the conventional classifications and did not provide more adequate therapeutic approaches. The aim of this paper is to explain the new nomothetic network psychiatry (NNP) approach, which uses machine learning methods to build data-driven causal models of mental illness by ensembling risk-resilience, adverse outcome pathways (AOP), cognitome, brainome, symptomatome, and phenomenome latent scores in a causal model. The latter may be trained, tested and validated with Partial Least Squares (PLS) analysis. This approach not only allows to compute pathway-phenotypes or biosignatures, but also to construct reliable and replicable nomothetic networks, which are, therefore, generalizable as disease models. After integrating the validated feature vectors into a well-fitting nomothetic network, clustering analysis may be applied on the latent variable scores of the R/R, AOP, cognitome, brainome, and phenome latent vectors. This pattern recognition method may expose new (transdiagnostic) classes of patients which if cross-validated in independent samples may constitute new (transdiagnostic) nosological categories.

Phenomenological Psychopathology and Psychoanalysis

Psychoanalysis and phenomenological psychopathology mark the beginning of twentieth-century psychiatry. They are two grand experiments against nineteenth-century neurological-criminological alienistics. Psychopathological experiences are not meaningless disfunctions, they both state. But psychoanalysis and phenomenology immediately part ways. Freud’s psychoanalysis reconstructs psychiatry around the idea of the unconscious, phenomenological psychiatry around the idea of consciousness. Psychoanalysis believes in causes, and the first unconscious cause is what Freud called drive, with its adventures and misadventures. Husserl’s phenomenology believes in the transcendental, and what we call psychopathological experiences are nothing other than the fading, the displacement, the fragmentations of the constitutive power of the transcendental.

Phenomenological Psychopathology and Clinical Decision-Making

This chapter examines how the phenomenological approach to psychopathology contributes to clinical decision making in psychiatry. It first considers competing forces in psychiatric clinical decision making, focusing in particular on the barriers that patients face in their search for a clinician to make their stories real. It then discusses factors that have contributed to the decline of phenomenological psychopathology, including the increase in importance of diagnostic classifications in psychiatry such as the Diagnostic and Statistical Manual, 3rd edition (American Psychiatric Association 1980); changes in the delivery of public mental health services; and increased attention to risk assessment for severe mental illness. It also describes clinical encounters with two patients that illustrate how phenomenological psychiatry can still contribute to sound clinical decision making.

Schizophrenic Autism

Schizophrenic autism, as originally intended by Eugen Bleuler, signifies a pathognomic form of motivated unmooring from the world into a state of asocial fantasy. In this article we discuss the unity of the three key aspects of this autism: (i) an altered relation to reality; (ii) a distinctive fantasy-involving form of thinking; and (iii) a motivated retreat from the world. Phenomenological psychiatry deepens our understanding of (i) by theorizing it in terms of disturbed pre-reflective intersubjective engagement, yet it deprecates the criteria of (ii) fantasy and (iii) motivation. We question the assumptions behind this deprecation, re-theorizing (ii) as withdrawal to a state in which a fantasy/reality distinction is compromised, and reinstating the motivational criterion (iii) through recovering a properly pre-reflective conception of dynamic motivation. The result is a conception of autism which preserves the unity of Bleuler’s concept by unifying phenomenological and psychoanalytical perspectives on the intersubjective constitution of selfhood.

Hubertus Tellenbach

Hubertus Tellenbach’s research on phenomenological psychiatry is characterized by both erudite scholarship and philosophical brilliance. Tellenbach’s most important contributions to psychiatry are to be found in four different areas of research: 1) the methodology of the psychopathological approach; 2) the study of melancholia; 3) the phenomenology of atmosphere and mood; and 4) an intercultural investigation of fatherhood. This chapter focuses primarily on the first two areas, although some aspects related to the third area are also mentioned. The last part of the chapter highlights the importance of Tellenbach’s analysis of the melancholic type to current research on depression. Tellenbach’s investigation can contribute to clarifying the connections between our society based on performance and optimatization and the alarming relevance of depression in our contemporary society.

Eugène Minkowski

This chapter discusses the psychopathological ideas of Eugène Minkowski, a French psychiatrist of Jewish Polish origin who is regarded as a dominant figure in phenomenological psychiatry due to his translation of theoretical and abstract philosophical notions into ordinary clinical work. After a brief biography, the chapter considers Minkowski’s psychopathological orientation, citing some of the influential figures in his life and work including Henri Bergson and Max Scheler. It then examines Minkowski’s notion of schizophrenia and what he refers to as vital contact with reality, which he describes as a basic mode of human presence in the world. It also looks at two forms of autism proposed by Minkowski, along with one of his most original concepts known as trouble générateur, or generative (generating) disorder. The chapter concludes with an assessment of the contemporary relevance of Minkowski’s ideas.

A meta-analysis of the core essence of psychopathological entities: an historical exercise in phenomenological psychiatry

Two fundamentally different approaches among phenomenological psychopathologists can be discerned. One is what we call fixed essentialism, where the pathognomonic element of, say, schizophrenia is conceived of as a single, enduring and intrinsically morbid way of grasping all entities in the world, including self and body. The other, which we call dialectical essentialism, accounts for the same manifestations of, say, schizophrenia, but through a process which is not life-enduring, and, most critically vis-à-vis the former formulation, is not in itself a single morbid defect: a morbid pattern of world, self and body is achieved by an imbalance between two or more otherwise healthy constituents of the ‘normal’ human being, whose imbalance and attempts to resolve this – the dialectic – induce the ‘morbidity’.