Some Remarks for an Agenda Regarding Phenomenologically Oriented Pharmacological Treatment of Schizophrenia

The project of therapeutic approaches sensible to the very subjective experience of patients suffering from schizophrenia, especially those treatments most used in current practice, as pharmacological, is and must always be and unambiguously welcomed.

Phenomenology is a rich and fertile tradition, born in modern academic philosophy (initiated by I. Kant and G.W.F. Hegel, but fully established by E. Husserl, and further developed by M. Scheler, K. Jaspers, and M. Heidegger, among others), that along the development of psychopathology in the twentieth century inspired sophisticated theories and new conceptual tools for clinical descriptions and understanding of mental patients and disorders such as schizophrenia, melancholia, or mania (Spiegelberg, 1972). Unfortunately, in the four or five last decades, it has lost much of its influence in psychiatry. Therefore, Tamelini and Messas’s contribution should be considered with open-minded attention and careful reflection.

Nevertheless, because their project is both ambitious and undoubtedly relevant, its assumptions, arguments, and conclusions must be rigorously analyzed. The ambition of their project is expressed by them in assertions as “a huge enterprise,” “renewal of the foundations of the psychiatric clinic,” “a paradigm shift,” and “a revolution in ideas, knowledge and research projects” (p. 140).

As a programmatic paper, the authors suggested that a new approach provided by phenomenological psychiatry should replace or at least have precedence over the mainstream psychiatric practice, because current pharmacological interventions frequently intend to a “mere removal of symptoms” and that “treating is not about merely removing the schizophrenic core” (p. 137). Because of the battle of ideas, principles, and values that certainly emerge in such a programmatic document, the definition of their field and tools must be better and more precisely formulated (Parnas & Sass, 2015).

It seems that the authors tend to treat phenomenology and anthropology in general and the phenomenological approach to schizophrenia as a conceptual homogeneous field or, at least, a not heterogeneous and disputing one. In the specific issue of schizophrenia, they claim that what phenomenological psychopathology looks for are “the essential core of schizophrenia,” “the understanding of the schizophrenic essence” or the “holistic understanding of the schizophrenic existence,” or even “the constitutive disturbance of schizophrenia” (p. 135).

This approach, not simple or humble, to the problem of schizophrenia will address a variety of phenomenological proposals of this type of psychosis such as Minkowski’s “loss of vital contact with reality,” Blankenburg’s “loss of natural self-evidence,” Sass and Parnas’ ipseity-disturbance hypothesis, hyper-reflexivity, diminished self-affection, and Stanghellini’s “bodily feelings of disintegration/violation.” It could add other no less relevant phenomenological approaches to schizophrenia such as Boss’s loss of Dasein as clearing (Lichtung) within Being, or Zutt’s end-of-the-world experiences (Spiegelberg, 1972).

The idea is that all species and strains of phenomenological approach to schizophrenia converge, as the authors ponder, in a kind of an intellectual collective that agree in their foundation (Sass & Borda, 2015). Nevertheless, such convergence must be better demonstrated. Is such convergence factual? Is it possible or desirable? Which of these essential cores of schizophrenia will be the common and acceptable notion for a research agenda and for clinical practice in the pharmacological treatment of schizophrenia? Or should each research group choose and use one of them, the view that proved to be more meaningful and appealing to the group?

Moreover, in their text, the authors recurrently mention anthropological principles, anthropological dialectic, anthropological tensions, balance, effects, pathways, and so on. It must be asked, which anthropology? Certainly, they are not considering social or cultural anthropology, but philosophical anthropology. Although an almost specific German philosophical tradition, this field is also quite heterogeneous with different authors such as Arnold Gehlen, Bernjard Groethuysen, Hans Jonas, Helmuth Plessner, Gerhard Arlt, Adolf Portmann, Ernest Cassirer, K. Jaspers, Victor von Weizsäcker, and Hans Gadamer. From which philosophical anthropology standpoint are the authors arguing (Andrea, 2009; Fischer, 2009)?

Because phenomenological psychopathology tends to be both an approach that looks for the fundamental singularity of each patient and also a kind of effort that pursues essences, cores or primary vital modification, the use of a...