Psychiatric Diagnosis and Classification - ResearchGate

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THE ROLE OF PHENOMENOLOGY IN PSYCHIATRIC DIAGNOSIS 155 first established by way of an analogical inference; on the contrary, it must be realized that there exists a distinctive mode of consciousness, often called empathy or simply ``Fremderfahrung'', that allows us to experience the feelings, desires, and beliefs of others in a more or less direct manner. To be more specific, empathy has typically been taken to constitute a unique form of intentionality, and one of the phenomenological tasks has consequently been to clarify its precise structure and to spell out the difference between it and other forms of intentionality, such as perception, imagination and recollection. A number of investigations have also been concerned with the way in which the very intentional relation between subjectivity and world might be influenced by intersubjectivity. It has been argued that a fundamental feature of those objects we first and foremost encounter in our daily life, namely artefacts, all contain references to other persons. Be it because they are produced by others, or because the work we are trying to accomplish with them is destined for others. Thus, in our daily life we are constantly embedded in an intersubjective framework regardless of whether or not there are de facto any others persons present. In fact, the very world we live in is from the very start given to us as already explored and structured by others. We typically understand the world and ourselves) through a traditional conventionality. We participate in a communal tradition, which through a chain of generations stretches back into a dim past: ``I am what I am as an heir'' [41]. In short, the world we are living in is a public and communal world, not a private one. Subjectivity and world are internally related, and since the structure of this world contains essential references to others, subjectivity cannot be understood except as inhabiting a world that it necessarily shares with others. Moreover, this world is experienced as objective, and the notion of objectivity is intimately linked with the notion of intersubjectivity. That which in principle is incapable of being experienced by others cannot be ascribed reality and objectivity. To put it differently, the objectivity of the world is intersubjectively constituted, and my experience of the world as objective is mediated by my experience of and interaction with other world-engaged subjects. Only insofar as I experience that others experience the same objects as myself, do I really experience these objects as objective and real. PHENOMENOLOGICAL CONTRIBUTION TO CLASSIFICATION Phenomenology, through its specific interest in consciousness, is particularly suitable for reconstructing the patient's subjective experience. Phenomenology does not consider consciousness as a spatial object; in fact the
156 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION fundamental feature of conscious experience is its intrinsically non-spatial nature. Consciousness is not a physical object but a dimension of phenomenality. Consciousness does not consist of separable, substantial ``thing-like'') components, exerting a mechanical±efficient causality on each other. Rather, the phenomenological concept of consciousness implies a meaningful network of interdependent moments i.e. non-independent parts), a network founded on intertwining, motivation and mutual implication [42], encompassing and framed by an intersubjective matrix. These views have important implications for psychopathological taxonomic endeavor. First, examination of single cases, as already pointed out by Jaspers, is very important. Reports from few patients, able to describe their experiences in detail, may be more informative of the nature of the disorder than big N studies performed in a crude, simplified way. Subjective experience or first-person perspective, by its very nature, cannot be averaged, except at the cost of heavy informational loss. In other words, in-depth study of anomalous experience should serve as a complement to strictly empirical designs. But even the latter may be dramatically improved, if the psychopathological examinations are phenomenologically informed. Second, a psychiatrist, in his diagnostic efforts, is always engaged in what is called a ``typification'' process [43, 44]. At the most elementary level, typification simply implies ``seeing as'', the fact that we always perceive the world perspectivally, i.e. we always see objects, situations and events as certain types of objects, situations and events e.g. when we see a bus driving away from a bus-stop and a man running in the same direction, we will tend to perceive the man as trying to catch a bus that he had missed) [45]. The most frequent type of typification is the pre-reflective and automatic one, linked to the corporeal awareness, and this holds for the diagnostic encounter as well. We sense the patients as withdrawn, hostile, sympathetic, eccentric, etc., and such typifications depend on our knowledge and experience, and will be perhaps modified upon further interactions with the patient. But we can also engage in reflective attitudes in order to make our typifications more explicit. The notion of typicality or of a prototype is crucial here: it is a notion important in all cognitive research [46±48]. Prototypes are central exemplars of a category in question: e.g. a sparrow is more typical of the category ``birds'' than is a penguin, which cannot fly and does not seem to have wings. Most cognitive and epistemic categories are founded upon a ``family resemblance'', a network of criss-crossing analogies between the individual members of a category [29], with very characteristic cases occupying central position, and less typical cases forming a continuum towards the border of the category, where the latter eventually blends into other, neighboring categories. Prototype can be empirically established by examining the cooccurrence of its various features; this happens tacitly in the formation of a
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PREFACE xi world who are interested
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2 PSYCHIATRIC DIAGNOSIS AND CLASSIF
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10 PSYCHIATRIC DIAGNOSIS AND CLASSI
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IMPLICATIONS OF COMORBIDITY 81 Fina
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IMPLICATIONS OF COMORBIDITY 83 It a
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IMPLICATIONS OF COMORBIDITY 85 leve
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IMPLICATIONS OF COMORBIDITY 87 ledg
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Table 4.2 Matrix of levels and subl
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IMPLICATIONS OF COMORBIDITY 91 unde
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IMPLICATIONS OF COMORBIDITY 93 Tabl
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IMPLICATIONS OF COMORBIDITY 95 For
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IMPLICATIONS OF COMORBIDITY 97 ``Ju
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IMPLICATIONS OF COMORBIDITY 99 Tabl
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PSYCHIATRIC DIAGNOSIS IN DEVELOPING
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282 INDEX AsociacioÂn PsiquiaÂtri
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284 INDEX consciousness in phenomen
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286 INDEX eating disorders 80 Eatin
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288 INDEX India contd) Unani/Arabic
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290 INDEX obsessive-compulsive diso
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292 INDEX St. Louis diagnostic crit
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294 INDEX US Navy classification 49
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Psychiatric Diagnosis and Classification - ResearchGate

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