- Knocking on Hard Science’s DoorHas the Time Come?
The discovery of antipsychotics and anti-depressants occurred when psychodynamic and phenomenological–anthropological approaches prevailed in psychiatry. Roland Kuhn personified that time as being one of the founders of Daseinsanalyse and also the discoverer of imipramine. Influenced by Binswanger and Scheler, Kuhn worked with the concept of “vital depressive disposition,” while emphasizing the preeminence of psychopathology over statistic methods (Kuhn, 1996). Consequently, he could not be satisfied with what he foresaw as “clouds of a coming disaster”:
Since that time, there has been a worldwide use of surveys, whose results are “exactly” tabulated with numbers, statistically evaluated, and represented in tables. People are fascinated by the scientific nature of this sort of activity and overlook just how disproportionately slight such gains are in the treatment of patients.(Kuhn, 1996, pp. 434–435)
Kuhn was at odds with the patient’s approach only from outside or in the third-person perspective, with positivistic or neo-positivistic contours, which was dominant in what has been called the second biological phase in psychiatry (after the first one that took place in Jaspers’s time). The problem is not with biological psychiatry per se, but rather with the sort of blind epistemological dogma in its self-sufficiency, with the “exact” numbers contributing to a deceptive sensation of certainty. The exaggerated optimism denoting this anti-metaphysical positivistic science was named by Brazilian psychiatrist Nobre de Melo (1981, p. 28) a “Theology without God.” It aims to turn all phenomena into thing-like objects in order for them to be subsumed under natural laws, including—and this is problematic—life, persons, and mind.
Standard psychopharmacological investigations follow this reductive materialist and determinist path: medications act on brain chemistry, neurons, or circuits that would explain mind and psycho-pathology. But physical things are by themselves devoid of mind or meaning. Ultimately, this presents a psychopharmacology without the psyche. We really need a much better method or a plurality of methods, a different episteme or paradigm. For example, aspects such as embodiment, enactivism, and affectivity in dynamic living organisms within their environments, viewed as a nonlinear dynamic system, would play a constitutive role concerning the mind (Maiese, 2016, pp. 1–48).
Phenomenology is a movement against that simplistic and deterministic—devoid of free will—materialization of life and the mind, as well as a research method that arguably is able to substantially enrich psychology and psychopathology. It is particularly concerned with going beyond (or digging behind) the natural attitude, as if illuminating the ineffable, an attitude in which positivistic science [End Page 143] is also immersed. In this way, phenomenology accesses pre-reflexive or aprioristic (“procedural,” in analogy to memory) structures in consciousness that make human experience possible.
Psychopathological phenomenology, an approach of psychopathology that goes beyond the descriptive and the clinical psychopathology (Stanghellini, 2009), is Tamelini and Messas’s (2019) bet to further inform psychopharmaco-logical treatment. Tamelini and Messas seem to have been developing the current theme for years by investigating phenomenological psychopathology in close connection with their clinical practice and teaching activities. Current uncertainties in biological psychiatry, owing to the lack of fulfillment of its optimistic expectations or owing to new challenges, make the task more imperative, although surely a complex one.
Tamelini and Messas (2019) also refer to “phenomenological psychiatry.” If we agree with Jaspers (1946, p. 1) that psychopathology is a science and psychiatry a practical occupation, once the goal is pharmacological therapy, that is, clinical practice, it might seem appropriate to speak of “phenomenological psychiatry.”
One of the well-investigated phenomenological structures is corporeality, the lived body. Here, I am not fully convinced about the therapeutic effect of weight gain (in a historical detour, one would say in Kretschmer’s time that leptosomic were turned more pyknic by clozapine). I am not confident about such a straightforwardly positive effect of antipsychotics on the lived body. Surely, they act in the living body, a physiological body far more complex than the anatomical Körper, but not equal to the lived body, the body as experienced. How weight gain in the living body could lead to a change in...