Psychiatry and the poverty of subjectivity: How phenomenology can contribute to the validation of categories of disorder

摘要

Psychiatry, and especially psychiatric classification, finds itself in a state of crisis. Recent criticisms have been leveled by patient advocacy groups, psychotherapists, and even psychiatrists (including the chairs of both the DSM-III and DSM-IV taskforces). Most notably, the National Institute of Mental Health (NIMH) announced - just weeks prior to the 2013 publication of the DSM-5 - that it will primarily fund studies that do not use the DSM-5 categories of disorder. In light of the problems of classification plaguing the field of psychiatry, a number of phenomenologists (including Aho, Parnas, Ratcliffe, Sass, Stanghellini, and Zahavi) have argued that contemporary phenomenological research into psychopathology should be used to guide the project of reclassification. While I agree with this claim, I argue that these phenomenologists have failed to delineate among a number of domains of phenomenological research. And, in failing to make such distinctions, are unable to distinguish between those areas of research that can be used to validate categories of disorder, and those that cannot. In order to remedy this issue in contemporary phenomenological psychopathology, I here propose three domains of phenomenological research - 1) existential structures, 2) modes, and 3) traditions. The first is understood as the domain of phenomenology proper, and consists of the categorial characteristics of human existence (e.g. intersubjectivity, embodiment, situatedness, etc.). The second is understood as the study of the various modes of these categorial characteristics (the modes of Situatedness, for example, include anxiety, boredom, joy, etc.). The third is understood as the domain of hermeneutics proper, but is often included in phenomenological studies. It consists of the framework of meaning that sediments throughout cultural and biographical developments, shaping what we see things as (e.g. people from different religious backgrounds will experience different objects as sacred, without actively interpreting the meaning of these objects).