A critical commentary on the article “The Epistemic Harms of Empathy in Phenomenological Psychopathology” by Lucienne Spencer and Matthew Broome (2023) is presented. The authors committed the “fallacy of ambiguous or vague definition” by incorrectly interpreting Karl Jaspers’ conceptualizations, resulting in difficulties following logical arguments and arriving at reasonable conclusions. To overcome this fallacy, the commentary provides conceptual clarifications regarding Jaspers’ empathic understanding (einfühlendes Verstehen), conceived as the foundational concept of his project to develop a phenomenologically oriented psychopathology. Jaspers initially (...) introduced this concept in the article “Die phänomenologische Forschungsrichtung in der Psychopathologie” [The Phenomenological Research Direction in Psychopathology], published in 1912, and extended in his magnum opus “Allgemeine Psychopathologie” [General Psychopathology], published in 1913. (shrink)

Delusions have traditionally been considered the hallmark of mental illness, and their conception, diagnosis and treatment raise many of the fundamental conceptual and practical questions of psychopathology. One of these fundamental questions is whether delusions are understandable. In this paper, we propose to consider the question of understandability of delusions from a philosophy of language perspective. For this purpose, we frame the question of how delusions can be understood as a question about the meaning of delusional utterances. Accordingly, we ask: (...) “what meaning(s) can delusional utterances possibly have?”. We argue that in the current literature, there is a standard approach to the meaning of delusional utterances, namely the descriptive account which assumes that a delusional utterance “p” means that p is the case. Drawing on Speech Act Theory, we argue that solely relying on the descriptive account disregards essential ways of how linguistic meaning is constituted. Further, we show that Speech Act Theory can prove a helpful addition to the theoretical and clinical “toolbox” used for attempting to understand delusional utterances. This, we believe, may address some of the theoretical and clinical shortcomings of using only the currently predominant descriptive account. (shrink)

There is a long tradition of employing a phenomenological approach to gain greater insight into the unique experience of psychiatric illness. Researchers in this field have shed light upon a distur...

This article challenges the consensus that silences about mental disorders are there to be broken. While silence in mental disorders can be painful, even deadly, the consensus rests on an oversimplified understanding of silence. Drawing upon accounts from depression and bipolar memoirs, this article names and analyses some salient experiences of silence in mood disorders. It does so with two goals in mind. The first is to show that mood disorders may involve several different kinds of lived experiences of silence. (...) This is important because even though silence is considered a promising objective symptom of depression, little has been written about lived experiences of silence in disorders that involve depression. The second is to argue against the fetishisation of breaking silence and the concomitant understandings of silence as an externally imposed and inherently negative phenomenon. This is important because some silences are not experienced as external and are even felt to be valuable, meaning that efforts to break them may be counterproductive. (shrink)

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research (...) of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (shrink)

In this article, we delve in debates around the usefulness of the notion of epistemic injustice in psychiatry to show that the concept has been misportrayed in the literature. We suggest that epistemic injustice should revolve around phenomenology and regard first and foremost the failure of mental health professionals to acquire and utilize information that service users are experts in, i.e. first-person testimony pertaining to what it is like to be them. We use this conceptualization to demonstrate the unique benefits (...) that the concept of epistemic injustice can bring to psychiatric practice, and we illustrate these through specific case studies, focusing particularly on autism. (shrink)

The current paradigm of mental health has fallen short in its promises to deliver better care and quality of life for those who lives with mental illness. Recent works have expressed the need for more comprehensive frameworks of research, in which phenomenology emerges as a fundamental tool for a new wave interdisciplinary studies with the humanities. In line with this project, this article hopes to explore the relation between education and phenomenologically oriented psychotherapy, through the work of Brazilian educator Paulo (...) Freire. First, we will briefly expose Freire’s biography and main ideas (such as the “banking model of education” and the creation of “culture circles”), showing how they can be useful during the clinical encounter. We will also highlight the importance of dialogical psychotherapy during situations of injustice and oppression. Finally, we will provide some insights that can help build a new paradigm of mental health that is based on a “praxis of freedom”, whether in research or clinical practice. We call this proposal a “Psychotherapy of the Oppressed”. (shrink)

Jaspers identifies empathic understanding as an essential tool for grasping not the mere psychic content of the condition at hand, but the lived experience of the patient. This method then serves as the basis for the phenomenological investigation into the psychiatric condition known as ‘Phenomenological Psychopathology’. In recent years, scholars in the field of phenomenological psychopathology have attempted to refine the concept of empathic understanding for its use in contemporary clinical encounters. Most notably, we have Stanghellini’s contribution of ‘second-order’ empathy (...) and Ratcliffe’s ‘radical empathy’. Through this paper, we reject the pursuit of a renewed version of ‘empathic understanding’, on the grounds that the concept is fundamentally epistemically flawed. We argue that ‘empathic understanding’ risks (1) error, leading to misdiagnosis, mistreatment and an overall misunderstanding of the experience at hand, (2) a unique form of epistemic harm that we call ‘epistemic co-opting’ and (3) epistemic objectification. To conclude, we propose that empathic understanding ought to be replaced with a phenomenological account of Fricker’s virtuous listening. (shrink)

Pozzi provides a thought-provoking account of how machine-learning clinical prediction models (such as Prediction Drug Monitoring Programmes (PDMPs)) may exacerbate testimonial injustice.1 In this response, I generalise Pozzi’s concerns about PDMPs to traditional models of clinical practice and question the claim that inaccurate clinicians are necessarily preferential to inaccurate machine-learning models. I then explore Pozzi’s concern that such models may deprive patients of a right to ‘convey information’. I suggest that machine-learning tools may be used to enhance, rather than frustrate, (...) this right, through the perspective of hermeneutical justice. Pozzi objects to the introduction of machine-learning risk prediction tools in clinical care, due to their being ‘epistemically opaque’, often inaccurate, and a threat to patients’ testimonial justice. Through the example of psychiatry, I suggest this stance idealises traditional models of clinical practice. I propose that clinicians’ judgements are often equally vulnerable to opaque subjectivity, bias and epistemic injustice. For instance, the use of clinical observation or collateral interviewing might be conceptualised as a threat to testimonial justice, by neglecting patients’ own perspectives or voices. In practice, clinical risk prediction often follows inconsistent and somewhat subjective clinical heuristics, which are difficult to summarise or evaluate. Further, although Pozzi diminishes machine-learning …. (shrink)

In this article, we investigate how distressing background feelings can be subject to social injustice. We define background feelings as enduring feeling states that condition our perceptions of everyday situations, interpersonal dynamics, and the broader social milieu. While phenomenological psychopathology has long addressed such affective phenomena, including anxiety, guilt, and feelings of not belonging, the intersection with social injustice remains largely unexplored within the framework. To address this gap, we introduce the concept of existential injustice into phenomenological psychopathology. Existential injustice (...) pertains to the unjust formation, perpetuation, and treatment of background feelings. We contend that distressing alterations in these feeling states can stem from, or be perpetuated by, unjust social structures and practices. Existential injustice manifests as a felt inadequacy of one’s background feelings, reflecting broader societal disparities and inequities. Drawing on themes from social psychiatry, we illustrate the utility and explanatory power of the concept through two concrete examples. By shedding light on the ways in which societal dynamics shape distressing affective experiences our analysis underscores the importance of integrating aspects of social injustice into the study of affective phenomena in phenomenological psychopathology. (shrink)

In his account of phenomenological psychopathology, Karl Jaspers advocates for the central role of subjective experience, something which he maintains cannot be accessed through intellectual effort, but through “empathic understanding” alone. In contradistinction to Jaspers’ account, I propose that phenomenology, as a process of inquiry and investigation, is fundamentally epistemological. Accordingly, I offer an intellectual virtue characterization of phenomenological psychopathology, using open-mindedness to illustrate the close conceptual links between the phenomenological endeavor and the intellectual virtues. By introducing the intellectual virtue (...) lexicon into the phenomenological psychopathology discourse, I then offer three preliminary recommendations for the training and education of phenomenological clinicians. Centering the educational recommendations on the psychiatric interview, I suggest that good questioning, listening, and reflecting necessarily require cultivation for intellectually virtuous phenomenological inquiry. (shrink)

Those who turn to phenomenological psychopathology as an answer to problems in psychiatric healthcare may find a philosophical tradition rooted in the early-mid 20th century that has done little to adapt to modern ideas in psychiatric healthcare and psychiatric research. The Renewing Phenomenological Psychopathology project, funded by the Wellcome Trust and led by Professor Matthew Broome and Professor Giovanni Stanghellini, calls for reflection, revitalization and reconstruction of this discipline, diversifying global scholarship and working with lived experience scholars, so that it (...) can pave new paths in psychiatric understanding. The contributions of the current special issue aim to breathe new life into a vital method in psychopathology and to chart its future trajectory. (shrink)