From Diagnosis to Therapeutic Empathy: A Journey into Recognition

Conceptually, recognition claims a cardinal role in many prominent philosophical theories. Kant, in the Critique of Pure Reason, uses the German word Rekognition—a term that in many ways has no antecedent in prior tradition—to signify the identification, the grasping of, a unified meaning through thought (Kant, 1998). However, it is through Hegel that a substantial step in practical philosophy is taken, and recognition is put into dialogue with self-consciousness and freedom. Hegel uses the German word Anerkennung, in the period of Jena Realphilosophie, to mean the "real" actualization of freedom through a struggle which leads to two different levels of recognition: legal and moral—their forms constituted by love and the state (Hegel, 1996). Hegel's notion of recognition is peculiar as it endeavors to satisfy a threefold quest: First, it ensures the link between self-reflection and orientation toward the other; in other words, the reciprocal determination of the relation between self and intersubjectivity. Secondly, recognition guarantees the dynamism of the movement which proceeds from the negative toward the positive, as stated in the Preface to The Phenomenology of Spirit. Finally, it draws those systematic aspects which will be articulated into hierarchical levels corresponding to specific institutions (Honneth, 1996). Precisely in the fourth chapter of The Phenomenology of Spirit, we encounter a self who is a purposive agent struggling for recognition, and we see how the transition from desire (Begierde) to recognition becomes the central point for subjectivity and its social features. Conceived as a process, recognition is not a "static" concept, rather it is a "movement" which concerns both subjectivity and intersubjectivity: it unveils the self as never isolated but rather always embedded into a plural dimension in which the I-Thou relationship is the pre-condition of the We-ness of existence (Binswanger, 1993).

The theoretical foundation of recognition shows us that recognition is a task which is accomplished by many struggles, whose ethical and epistemic aspects are closely linked, as opposed to being an automatic mechanism (Stanghellini, 2017). In the field of psychotherapy, this bond and the related struggles are pivotal. A person-centered approach is possible only if both the patient and the therapist can achieve a mutual and challenging recognition which implies not only the therapeutic relationship but also the construction of a therapeutic empathy centered on three main features: understanding, communicating and acting in a helpful therapeutic way (Howick, Bizzari, & Dambha-Miller, 2018). When we refer to recognition in the broad scenario of mental health, we do not refer to the automatic and standardized pattern-recognition processes which take place into the diagnostic process. Instead, we refer to a complex and nuanced process which involves the individual subjects implicated into this process—the I–Thou relation and the meaning-making process. If we want to trace the roots of this process, we must go back to Freud, who claims that the recognition of alterity is an indiscernible part of our subjecthood: Freud paves the way to the reconciliation between the person and their own alterity (Freud, 1914). However, the journey from diagnosis to therapeutic empathy is complicated and infeasible if we depart from the issue of recognition. The quest (and struggle) for recognition calls into discussion both the very process of diagnosis and the epistemic models which ground the diagnostic classification systems, showing the limits of certain metaphysical views in understanding psychopathological phenomena (Zachar, 2014) as well as the need for reassessing those concepts and values at the core of therapeutic practices (Brencio & Bauer 2020).

On the faint trail leading from diagnosis to therapeutic empathy, the contribution of Gilardi and Stanghellini is particularly illuminating and it shows how the struggle for recognition is a struggle in life, against life, by life (Ricoeur, 1977). It is not simply the description of a clinical case or a mere account of a conversation between a patient and his therapist; rather is it a philosophical dialogue embedded into the inescapable dimension of recognition. Lorenzo Gilardi received a diagnosis of schizophrenia, and he discusses with Giovanni Stanghellini what it means to be schizophrenic in terms of recognition. The dialectic...