Phenomenology and Psychopathology

In this response to Wiggins and Schwartz, Ratcliffe, and Stanghellini, we first wish to express our gratitude to Philosophy, Psychiatry, and Psychology for providing us the space to clarify our views and to overcome certain misunderstandings. Ratcliffe notes that our critique is "harsh," whereas Wiggins and Schwartz lament the fact that the debate "has taken the form of sometimes acid formulations and rejoinders . . . that lack the tone of mutual appreciation" (2011, 31). We deplore the fact that this exchange was at all necessary, and we share Wiggins and Schwartz's concerns. However, we need to recall here and emphasize that our article originated as a response. It originated as a response to an article that was published in an update-review journal for a general psychiatric audience. It seems that Aaron Mishara was not only the author, but also the editor of the section in which his own article appeared. We were unable to ignore his paper, not least because of its form and tone, and deemed it rather pressing to clarify the avalanche of misunderstandings there—misunderstandings and twists that if left uncommented, could create a confusing picture of psychiatric phenomenology.

We turn now to the issue of phenomenology's relation to empirical sciences in general and to psychiatry in particular. The three of us—a psychiatrist, a psychologist, and a philosopher—have different training and intellectual trajectories. What brought us together was "doing phenomenology," primarily in the context of clinical work, empirical research in schizophrenia, and conceptual work in psychopathology. Here, as Ratcliffe remarks, "rather than pitting various phenomenological thinkers, methods and claims against each other, it is possible to adopt an approach that draws insights from a range of sources, the ultimate goal being a cohesive view that brings together the best of what they have to offer" (2011, 33). We have attempted to argue in theoretical publications and to demonstrate through empirical research that we, indeed, consider phenomenology to be indispensable for psychiatry in its praxis of clinician-patient interaction, diagnosis, therapy, theoretical work, formation of pathogenetic hypotheses, and empirical data collection.

We agree with Wiggins and Schwartz's point that all results of scientific endeavors are in a certain sense and to various degrees provisional; there is, of course, nothing controversial in holding such a view. A pathogenetic theory/hypothesis of early research stages has important heuristic value, for example, through directing our attention to certain ways in which to conceive of and design research (e.g., Owen et al. 2007) or to act therapeutically. On the other hand, we do not think that we need a future arbiter to decide on whether the patients with schizophrenia spectrum disorders report a variety of profound changes in self-experience, often beginning in early childhood. This seems to be more of the order of a datum, not discovered by us, but revived, and carefully studied through many years of effort.

We agree that the IHM model as a pathogenetic version of the generative disorder or "core" is a hypothesis in need of empirical testing. Intuitively, it seems to us quite likely that a pervasive sense of self-dissolution, nonexistence, or anonymity must lead to some phenomenal consequences over the course of illness. Concerning the issue of anomalies of self-experience as belonging to the "core" in its phenomenological descriptive sense, alluded to by Minkowski, we will adhere to our claim that self-disorders constitute an essential clinical aspect of the conceptual validity of schizophrenia, of its prototypical Gestalt, of what schizophrenia is in the very first place (Parnas et al. 2002; Ufer-Parnas et al. 2010). The role of such typifications in the diagnostic process, together with other critical reflections on diagnosis, were masterfully presented to the psychiatric audience by Schwartz and Wiggins in their important contribution on the nature of psychiatric diagnosis and diagnostic process (Schwartz and Wiggins 1987a, 1987b) and by Sadler et al.'s invaluable collection on philosophy of psychiatric nosology (Sadler et al. 1994). Unfortunately, today such considerations are often ignored because of a behavioristic tendency toward reification and simplification of...