Phenomenological and Biological Psychiatry: Complementary or Mutual?

Keywords: phenomenology, psychiatry, psychoanalysis, ontology.

 

We feel that even if all possible scientific questions be answered the problems of life have still not been touched at all.

(Witgenstein, Tractatus, 6.52)

IF ONE WAS TO PERFORM a thought experiment by imagining a scientifically explained universe, how would this explained universe resolve my issues of value and meaning? Would it help me to live a better life? In one sentence, Witgenstein expressed exactly the issues dividing, and defining, the phenomenological and biophysical approaches to psychiatry. (Natural) scientific questions are concerned with relations of physical causality while phenomenology is aimed at the problems of life, i.e., the elucidation of lived personal meanings.

Clarifying the relation between phenomenology and the general psychiatric literature is clearly a significant undertaking. At this juncture in the history of psychiatry where the biophysical model is so dominant, the authors' efforts are especially welcome, as I wholeheartedly appreciate, and thank the authors for this endeavor. I only wish to explicate a few issues latent within the article and perhaps add a few supportive points. Explicitly or implicitly, the need for phenomenology in psychiatry is long enduring and will always persist (Ellenberger 1981, 1993). The integration of phenomenology with general psychiatric practice would certainly serve the needs of patients and society generally. But, in the present state of affairs where the biological model is so preeminent, a full accounting of the dramatic divergences between the two approaches is necessary if there is to be authentic dialogue between them.

Essentially, I want to stress that phenomenology and natural science medicine are genuinely distinct paradigms for construing reality and organizing knowledge. As distinct scientific paradigms, each one is holistically self-contained. Like soap bubbles, if pushed together too forcefully one or the other may burst. In this case, it is more likely that the smaller, less prevalent paradigm would burst by becoming absorbed into the more dominant paradigm. I believe that this is precisely the risk when phenomenology is introduced to conventional psychiatry as "complementary." Whereas one could hardly object to any application of empathy and understanding toward the experiences of patients, it would be tragic if the full philosophical power of phenomenology were to be overlooked in favor of its mere utility as a preliminary stage of diagnosis and assessment, a framework for bedside manners, or worst of all, an appendage to neuroscience or pharmacology. This would not be phenomenology but the very symptomatology that the authors have has so clearly distinguished from true phenomenology.

This equation of phenomenology with symptomatology is exactly the misunderstanding that the authors so effectively address. However, I would hesitate to join the authors' optimism in regard to phenomenology's potential complementary role to conventional psychiatric practice. Furthermore, in the process of paradigm mix, certain constituents of each paradigm may be taken out of context and the strength of each paradigm thus diluted. For example, the very power of the experimental method is its reduction of phenomena to measurable variables that can be altered in order to discern causality. Unmeasurable variables detract form the rigor of this entire approach. Then on the other hand, phenomenological empathy is only possible within a standpoint that is severed from the causal thinking of experimental science. This is the holistic perceptual shift that cannot be accomplished when one only appends phenomenological insights to an otherwise materialist approach to psychiatry. Thus, it is not at all clear how one can be both phenomenological and nonphenomenologically natural scientific. Instead of positioning phenomenology as a potential complimentary component of natural-science psychiatry, both world views need to be examined, on their own terms, in a framework of mutuality.

Empathy or the understanding of other peoples subjective experience is indeed an essential component of the application of phenomenology to clinical assessment and especially therapeutic treatment. But, to limit phenomenology to this theme alone may not honor the profoundly radical character of this paradigm. As the authors point out, phenomenology asks the practitioner to...