But never let it be doubted that depression, in its extreme form, is madness. (Styron, 1990, p. 62)There is nothing wrong with our biology or our intelligence; sometimes we are just stuck. (Cvetkov...

Since Erich Lindemann's seminal work on 'the symptomatology and management of acute grief' from 1944, it has been common to define grief through its particular emotional structure and dynamics. According to this perspective, grief announces itself in socalled 'pangs of grief' in which the bereaved is occasionally flooded by waves of emotions. This picture has become so ingrained in our understanding of grief that it has defined both public discourse on grief and contemporary clinical constructs. In this paper, I propose (...) that underneath grief's fluctuating emotivity, there is a deeper feeling of grief. This deeper feeling reflects an altered mode of being in the world in which the bereaved experiences herself as 'at a distance' from the worldly. I will refer to this state as world-distancing and emphasize it as a protective affective state that shields the bereaved from a limit situation in which the world has become overwhelming in the absence of the deceased. It is experienced as being in a bubble or as if enclosed in a kind of membrane that shields the bereaved from the intrusiveness and penetrating character of the world. Worlddistancing, however, comes with significant perils if the bereaved are unable to reattach to the world. I outline this danger as a state of existential loneliness that follows from what Eugené Minkowski termed a felt lack of vital contact with the world. (shrink)

In this paper, I develop a phenomenological account of social anxiety disorder (SAD) as a disturbance of lived time through an analysis of first-person accounts informed by Minkowski’s notion of disordered temporality. The core psychopathology of the patient, I argue, is a constricted sense of relational time. Instead of the ordinary sense of a taken-for-granted shared future, the patient experiences time as running a predetermined course toward their social death. This manifests itself in a relational life lived as if it (...) might end at any moment or has already done so. Patients describe the end of their current relationships as self-evident and struggle against it by attempting to evade its immediate occurrence and to postpone it into the less eminent future. At times, patients succumb to passivity and self-blame, revelatory of a sense of an entirely lacking relational future. This phenomenological conceptualization provides an alternative to the predominant cognitive-behavioral (CBT) account of SAD. The CBT approach conceptualizes the core disorder as a set of dysfunctional beliefs about other people’s opinion of the patient. The phenomenological account elucidates a part of the subjective background on which these beliefs come to make sense to the patient. Further, with its concept of social death, the phenomenological account captures the existential contexts, which makes the intensity of the patient’s fear of rejection comprehensible. This way of understanding the patient and their psychopathology has important implications for diagnostic and psychotherapeutic practice. (shrink)

Definition of the problem: The connection between time and the good life has already been worked out for a number of medical specialties and practices. However, what role does the temporality of the good life play for medicine as a whole? That is the central question of this article. Arguments: The good life is here understood as a meaningful life. Living meaningfully is only possible through present action. A fulfilled presence in this sense is therefore an essential aspect of the (...) temporality of the good life. Illness tends to prevent a fulfilled presence. In this respect, medical treatments aim to enable a fulfilled presence. A second structure of time, that is central to the good life, consists in the chronobiological rhythms, upon the maintenance and restoration of which health is critically dependent. Conclusion: The temporality of the good life has a twofold relevance for medicine as a whole. First, the purpose of medical treatment is to enable a fulfilled present. Second, this can and should be done by maintaining and restoring chronobiological rhythms. ++++ Der Zusammenhang von Zeit und gutem Leben wurde bereits für eine Reihe medizinischer Disziplinen und Praktiken herausgearbeitet. Doch welche Rolle spielt die Zeitlichkeit des guten Lebens für die Medizin insgesamt? Das ist die leitende Frage dieses Artikels. Dabei wird das gute Leben als sinnvolles Leben verstanden. In diesem Sinne wird für eine zweifache medizinische Relevanz der Zeitlichkeit des guten Lebens argumentiert: Erstens besteht der Sinn medizinischer Behandlungen in der Ermöglichung erfüllter Gegenwart. Zweitens kann und sollte ebendies u. a. durch die Wahrung und Wiederherstellung der chronobiologischen Rhythmen geschehen. (shrink)

Melancholia is an attunement of despair and despondency that can involve radical disruptions to temporal experience. In this article, I extrapolate from the existing analyses of melancholic time to examine some of the important existential implications of these temporal disruptions. In particular, I focus on the way in which the desynchronization of melancholic time can complicate the melancholic’s relation to death and, consequently, to the meaning and significance of their life. Drawing on Heidegger’s distinction between death and demise, I argue (...) that melancholic time leaves the melancholic in an impossible state of existing, where they are both unable to live and unable to die. Turning to the role of the physician, I consider the significant role that clinical interventions might have in resynchronizing the melancholic with time and examine these ideas further through a case study on physician-assisted suicide. In so doing, I demonstrate that the desynchronization of melancholic time should indeed be understood as a matter of life and death. (shrink)

A possible solution is offered to help resolve the “two times problem” regarding the veridical and illusory nature of time. First it is recognized that the flow of time is part of a wider array of temporal experiences referred to as manifest time, all of which need to be reconciled. Then, an information gathering and utilizing system model is used as a basis for a view of manifest time. The model IGUS robot of Hartle that solves the “unique present” debate (...) is enhanced with veridical and illusory components of not only the flow of time but also the larger entity of manifest time, providing a dualistic IGUS robot that represents all of the important temporal experiences. Based upon a variety of prior experiments, that view suggests that the veridical system is a reflection of accepted spacetime cosmologies and through natural selection begets the illusory system for functional purposes. Thus, there are not two opposing times, one outside and one inside the cranium. There is just one fundamental physical time which the brain developed, now possesses and is itself sufficient for adaption but then enhances. The illusory system is intended to provide a more satisfying experience of physical time, and better adaptive behavior. Future experiments to verify that view are provided. With a complete veridical system of temporal experiences there may be less need to reify certain temporal experiences so that the two times problem is less of a problem and more of a phenomenon. (shrink)

Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients’ conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and (...) conscious level.We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness. (shrink)

As an alternative to linear and unidimensional perspectives focused mainly on either organic or psychological processes, the enactive approach to life and mind—a branch of 4-E cognitive theories—offers an integrative framework to study mental disorders that encompasses and articulates organic, sensorimotor, and intersubjective dimensions of embodiment. These three domains are deeply entangled in a non-trivial manner. A question remains on how this systemic and multi-dimensional approach may be applied to our understanding of mental disorders and symptomatic behavior. Drawing on Gilbert (...) Simondon’s philosophy of individuation, we provide some enactive conceptual tools to better understand the dynamic, interactive, and multi-dimensional nature of human bodies in mental disorders and psychopathological symptoms. One of such tools cursiva is sense-making, a key notion that captures the relational process of generating meaning by interacting with the sociomaterial environment. The article analyzes five aspects related to sense-making: temporality, adaptivity, the multiplicity of normativities it involves, the fundamental role of tension, and its participatory character. On this basis, we draw certain implications for our understanding of mental disorders and diverse symptoms, and suggest their interpretation in terms of difficulties to transform tensions and perform individuation processes, which result in a reduction of the field of potentialities for self-individuation and sense-making. (shrink)

Despite its complex experiential structure, the phenomenon of grief following bereavement has not been a major topic of phenomenological research. The paper investigates its basic structures, elaborating as its core characteristic a conflict between a presentifying and a ‘de-presentifying’ intention: In grief, the subject experiences a fundamental ambiguity between presence and absence of the deceased, between the present and the past, indeed between two worlds he lives in. This phenomenological structure will be analyzed under several aspects: regarding bodily experience, as (...) disruption of a shared intercorporeality; as a loss of the shared world and shared habitualities, leaving the bereaved person with ubiquitous indications of absence and with a contraction of their own self; regarding temporality, as a separation of two strands of time, namely a still ongoing past and an alienated present which become more and more desynchronized; finally, as an “as-if presence” of the deceased which the bereaved continue to feel and sometimes to perceive, leading to a cognitive-affective conflict between two experienced realities. The transforming process of grief is then analyzed as a gradual adjustment to the loss, finally enabling a re-integration of the conflicting realities. This is achieved through an incorporation and identification with the deceased on the one hand, and through various forms of representation on the other hand, in particular by recollection and symbolization. (shrink)

A partir del marco teórico de la fenomenología husserliana —afín al reciente enfoque dimensional de clasificación psicopatológica—, este escrito propone un análisis comparativo de la depresión y la esquizofrenia. Tras desarrollar algunas ideas básicas de Husserl sobre la descripción fenomenológica de la consciencia temporal, se profundiza en cómo estas bases teóricas pueden fundar una concepción de las mencionadas enfermedades mentales. En este sentido, se apela principalmente a Fuchs y Ratcliffe, quienes consideran que una anomalía en la experiencia de posibilidad daría (...) la clave para precisar tanto la experiencia depresiva como la esquizofrénica. El resultado de este análisis comparativo señala que la diferencia entre las psicopatologías en cuestión recae sobre el carácter de la anomalía de la experiencia de posibilidad: mientras la depresión apunta a una reducción de experiencias de posibilidad práctica, la esquizofrenia refiere a una fragmentación de la consciencia temporal debido a una disfunción protensional. (shrink)

Contemporary psychiatry finds itself in the midst of a crisis of classification. The developments begun in the 1980s—with the third edition of the Diagnostic and Statistical Manual of Mental Disorders —successfully increased inter-rater reliability. However, these developments have done little to increase the predictive validity of our categories of disorder. A diagnosis based on DSM categories and criteria often fails to accurately anticipate course of illness or treatment response. In addition, there is little evidence that the DSM categories link up (...) with genetic findings, and even less evidence that they... (shrink)

In this paper I offer an alternative phenomenological account of depression as consisting of a degradation of the degree to which one is situated in and attuned to the world. This account contrasts with recent accounts of depression offered by Matthew Ratcliffe and others. Ratcliffe develops an account in which depression is understood in terms of deep moods, or existential feelings, such as guilt or hopelessness. Such moods are capable of limiting the kinds of significance and meaning that one can (...) come across in the world. I argue that Ratcliffe’s account is unnecessarily constrained, making sense of the experience of depression by appealing only to changes in the mode of human existence. Drawing on Merleau-Ponty’s critique of traditional transcendental phenomenology, I show that many cases of severe psychiatric disorders are best understood as changes in the very structure of human existence, rather than changes in the mode of human existence. Working in this vein, I argue that we can make better sense of many first-person reports of the experience of depression by appealing to a loss or degradation of the degree to which one is situated in and attuned to the world, rather than attempting to make sense of depression as a particular mode of being situated and attuned. Finally, I argue that drawing distinctions between disorders of structure and mode will allow us to improve upon the currently heterogeneous categories of disorder offered in the DSM-5. (shrink)

Time plays a significant role in science and everyday life. Despite being experienced as a continuous flow, computational models of consciousness are typically restricted to a sequential temporal structure. This difference poses a serious challenge for computational phenomenology—a novel field combining phenomenology and computational modelling. By analysing the temporal structure of the active inference framework, we show that an integrated continuity of time can be achieved by merging Husserlian temporality with a sequential order of time. We also show that a (...) Markov blanket of the present moment integrates past and future moments of both subjective temporality and objective time in an asynchronous manner. By applying the integrated continuity, it is clear that active inference makes use of both subjective temporality and objective time in an integrated fashion. We conclude that active inference, on a temporal note, qualifies as a computational model for phenomenological investigations. (shrink)

This dissertation combines two scientific disciplines and research fields, namely philosophy and psychopathology. Within such a wide field of investigation, two precise perspectives are to be adopted in this inquiry: stemming from the first field, the phenomenological perspective on subjectivity and intersubjectivity; stemming from the second, the psychopathological perspective on schizophrenia. The combination of philosophy and psychopathology has often proven fruitful. Moreover, the main motivation for such combined approach is justified by the strong belief that, when critically used, phenomenology offers (...) a viable method of studying the first-personal perspective of experience, including the experiences of people with mental disorders. Philosophical analysis can thereby be used as a means to evaluate the meaning and adequacy of psychopathological concepts and ideas. As a result, phenomenological psychopathology may help understand what is often claimed to be incomprehensible. Particularly for the understanding of schizophrenia, this is taken to be a valuable contribution. For more than twenty years now, the phenomenological approach to schizophrenia has developed a strong and influential hypothesis on the basic alterations of this disorder. Schizophrenia, it is claimed, is a disorder of subjectivity, and more specifically, a disorder of the minimal self. Simultaneously, and often in conjunction, philosophical research on the self has vastly proliferated. The vivid interaction between these two fields makes the phenomenology of schizophrenia a good example of effective interdisciplinary work. Within the philosophical debate on subjectivity, intersubjectivity, or the relation between self and other, is currently a key topic. However, this has not significantly influenced the psychopathology of schizophrenia yet. The initial and fundamental claim of this dissertation is indeed that a renewed evaluation and inclusion of intersubjectivity, next to subjectivity, is to increase the validity of the phenomenological approach to schizophrenia. This would allow the previous hypothesis on schizophrenia as minimal self disorder to be challenged, criticized, or complemented, which would accordingly increase the significance and its clinical value. What I will attempt to do in this dissertation is then to thoroughly evaluate the role of intersubjectivity in schizophrenia. It will hence become clear what this role and its significance are. Consequently, I will finally argue that the basic alterations of schizophrenia concern both subjectivity and intersubjectivity. My argument is developed in four chapters. In the first, I introduce the topic of the self, including the distinction between the minimal and the extended self. This chapter equally introduces schizophrenia as a psychiatric concept, and three different clinical approaches are discussed, among which the phenomenological approach in most detail. After the topics of the self and schizophrenia, I introduce intersubjectivity, notably from a developmental-psychological perspective. By way of status quaestionis, I recapitulate the current research on intersubjectivity and schizophrenia. It will become clear that this research is relatively scarce. I then conclude the chapter with a full formulation of the two research questions informing this dissertation, namely Is schizophrenia an intersubjectivity-disorder? and Which self-concept is suited to define schizophrenia as a self and intersubjectivity disorder? The second chapter examines the phenomenology of intersubjectivity. The exact delineation of what is meant here by intersubjectivity will allow the reader to acknowledge its extent and variety. This chapter is aimed to provide the necessary philosophical tools to analyse schizophrenia in the light of intersubjectivity. In the third chapter I turn to psychopathology. In the first section, I analyse the work of seven major psychopathologists on schizophrenia. The goal of this section is to look for elements of intersubjectivity in their accounts of schizophrenia. Many of these psychopathologists have been influential for the development of the current self-disorder hypothesis, and the investigation intends to show how some crucial intersubjective elements in their work have been neglected. In the second section of this chapter, I focus on the symptoms, signs, and phenomena of schizophrenia that relate to intersubjectivity. This chapter finally offers all the material needed to positively answer the first research question. In the fourth chapter, I bring together psychopathology and philosophy, and I attempt to answer the two research questions. Since Chapter 3 allows me to affirmatively answer the first question, I examine whether the current self-disorder hypothesis is adequate to integrate intersubjectivity disturbances. It will appear that it is not, and the first section of this chapter consequently deals with the question why intersubjectivity and its disturbances have been neglected until now. In the second section it will become clear that no different self-concept is required, but that schizophrenia primarily concerns a particular capacity or orientation of subjectivity. I introduce the concept of open subjectivity and thereby answer the second research question. By describing schizophrenia as a disturbance of open subjectivity, I am finally able to integrate both self-disturbances and intersubjectivity-disturbances into a coherent and unified theory. To conclude this dissertation, I summarize and recapitulate its major issues, questions, and results in Chapter 5. Both clinical implications and possible future research are also discussed here. (shrink)

The objective of this study is to present a theoretical paper about a clinical issue. Our aim is to propose some clinical and semiological considerations for a psychopathological conception of psychopathy. We will discuss several major theoretical works dedicated to this nosographic entity. We will also examine a significant issue raised by Cooke et al., namely whether psychopathic functioning is consistently related to antisocial behavior. This theoretical essay is informed by clinical situations. The method applied a phenomenological psychopathology analysis to (...) the clinical material. We first compare Binswanger’s conception of mania with psychopathic functioning. Patients’ behavior is similar but there is a difference related to the dialectic between the ego and the alter ego. A patient with mania has a fundamental crisis of the ego, which a psychopath does not have. A second finding of our investigations concerns emotions and the adaptive dimension of the psychopathic disorder. An epistemological discussion of the concept of emotions reveals that psychopaths are competent in the management of emotional stimuli, which confers a psychological advantage upon them. (shrink)

The aim of this paper is to study anomalies of self- and world-experience in schizophrenia from a phenomenological perspective, through the use of the EASE and the EAWE interviews. Four patients with diagnoses of schizophrenia were interviewed with both EASE and EAWE. A qualitative analysis of these interviews was carried out on all the data; quantitative scores were also assigned based on the frequency and intensity of items endorsed by the subjects. For the EASE, subjects endorsed an average frequency of (...) 45% of all items. For the EAWE, subjects endorsed an average frequency of 26% of all items. Furthermore, EAWE data indicated more heterogeneous profiles of experience than the EASE. This heterogeneity is not surprising, given that the EAWE was designed to be a more broad-based or less targeted exploration of various changes likely to be associated with schizophrenia spectrum. Our data suggest that, although disturbances of world experience may always be present in schizophrenia, they may take numerous and varied forms. Because the experience of the world occurs across many different modalities, disturbances of this experience would be fundamentally less unitary, whereas the experience of the self present a more coherent and unitary gestalt. These results show certain overlapping between the scales while also indicating the potential value of combined use of the two instruments. Finally, we discussed the relationship between experiential description and behavioral observation, and their potentially complementary value in exploring the first-person perspective, particular in the case of experiences that occur at a more pre-reflective level. (shrink)

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)