A Step Beyond Psychopathology: A New Frontier of Phenomenology in Psychiatry

Critical-philosophical commentary on theses defended in scientific articles may be guided by two distinct perspectives, each leading to inquiries and styles of responses that are both distinct and complementary: an internal perspective and an external perspective. The internal commentator belongs to the same epistemological field of the authors and, as such, shares the same categorical assumptions and the same Weltanschauung explored in the text. The dialogue with this commentator emphasizes the minutiae of the observation of the shared scientific reality and points out the frontiers toward which the discussion of a scientific branch must advance. The external commentator, in contrast, emphasizes the categorical contrasts and semantic differences between the scientific field to which this commentator belongs and the one to which the authors belong. Their inquiries summon the authors to an explanation of their concepts. The valuable comments of Daker and Dalgalarrondo to the article “Principles for pharmacological treatment of schizophrenia in light of phenomenological psychopathology” correspond with internal and external criticisms, respectively. Both allow key points in the proposed discussion to receive further clarification.

Before trying to reflect on some aspects raised by the commentators, additional notes are addressed. We share the position that “to consider phenomenology as a purely descriptive science of the way the world appears to be experiencing subject is a serious misunderstanding” (Stanghellini, 2011, p. 29) and that it is the task of psychopathology itself to expand its notorious relevance to clinical practice (Mullen, 2006). However, the transposition of scientific findings from phenomenological psychopathology to psychiatric practice is still a subject of debate in the contemporary literature. Despite the obvious complexity involved in the dialogue between psychopathology and empirical studies, our contribution to this volume of the PPP aims precisely at endorsing the view that critical appreciation of clinical care is the next frontier of the phenomenological research agenda in psychiatry. We believe that a phenomenologically guided therapy is a doable and desirable pragmatic attempt “not only because of the historical legacy of phenomenology but above all its living potential to deal with the dilemmas and challenges still in force in psychiatry today.” Recent studies begin to propose hypotheses in this direction, in line with the understanding that “core insights into the disorder result as well as core treatment implications” (Moskalewicz & Schwartz, 2018, p. 8). In other words, our aim is to broaden the scope of epistemological foundations already rooted in the psychiatric tradition, but still largely unexplored. This general ambition can only be presented by way of a very restricted example, in this case, a specific property of the antipsychotics in schizophrenia. Without the explanation of the thesis, by means of examples, the article would be no more than an empty manifesto. On the other hand, the presentation of a single example means in itself the possibility of exploring an investigative path, justifying the evocation of a reform of the psychiatric therapeutic agenda.

Let us turn to the answers to some of the questions raised, beginning with internal criticism. Daker pertinently inquires: “How weight gain in the living body could lead to a change in the pre-reflexive structure of corporeality?” (p. 144). As the commentator himself explains, there is a common phenomenological distinction, although permeated by ambiguities and heterogeneity in the philosophical and psychopathological literature (Fernandez, 2016), between the lived body (Leib) and the corporeal body (Koerper). These two dimensions constitute the body, which is “a form of subject-object, neither purely that which perceives, nor which is perceived, but constantly both” (Bowden, 2012, p. 231). Regarding the Leib/Koerper polarity, however, it is important to note that taking the corporeal body as a “foreign body in the original life-world of prereflective experience” (Fuchs, 2002, p. 224) would only replace the classic mind–body dualism. And if, under normal conditions, “an ongoing oscillation between these two bodily modes constitutes a fluid and hardly noticed foundation of all experiencing” (Fuchs & Schlimme, 2009, p. 571), in psychopathological contexts, this dialectical balance is modified. In phenomenological terms, schizophrenia is a particular kind of severe modifications of consciousness, which can be...