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)

Understanding alterations of selfhood (termed self-disorders or self-disturbances) that are considered typical of the schizophrenia-spectrum is a central focus of phenomenological research. The currently most influential way of phenomenologically conceiving self-disorders in schizophrenia is as disorders of the so-called most basic or “minimal self”. In this paper, we first highlight some challenges for the minimal self-view of self-disorders, focusing on (1) problems arising from the supposedly “essential” or “universal” nature of minimal self with respect to phenomenal awareness and (2) the (...) critical implications of alterations of self-experience in schizophrenia that involve heightened or exaggerated sense of self. In the second part, we tentatively explore how a (non-egological) transparency-view of consciousness may offer an alternative way of understanding the experiential abnormalities involved in self-disorders in schizophrenia. We discuss how such a transparency-view (1) may account for loss-of-self experiences; (2) is compatible with the key notion of “hyper-reflexivity”; and (3) can help explain instances of self-disorder involving increased sense of self. In conclusion, we consider some possible advantages of this alternative view for research on self-disorders and clinical approaches. (shrink)

Dass wir alle in einer gemeinsamen Wirklichkeit leben, setzen wir meist unhinterfragt voraus. Sehen Andere die Welt dann doch einmal anders, mag es uns scheinen, als sähen sie diese einfach nicht so, wie sie wirklich ist. Schwerer fällt uns anzuerkennen, dass andere zuweilen in ganz anderen Wirklichkeiten unterwegs sind als wir selbst. - Tom Poljansek zeigt, wie sich die Vorstellung einer Pluralität menschlicher Wirklichkeiten mit der Annahme einer wahrnehmungsunabhängigen Realität vereinbaren lässt, ohne sich in einen Relativismus der vielen Wirklichkeiten zu (...) verlaufen. In Auseinandersetzung mit »kontinentalen« und »analytischen« Ansätzen legt er eine elegante Theorie menschlicher Wirklichkeiten vor, die konstruktivistische und realistische, phänomenologische und naturalistische Motive unerwartet miteinander verbindet. (shrink)

The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be (...) addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility. (shrink)

This essay asks after the lateness that affectively structures Fanon's phenomenology of racialized temporality in Black Skin,White Masks. I broach this through the concepts of possibility, “affective ankylosis”, and by taking seriously the dismembered past that haunts Fanon's text. The colonization of the past involves a bifurcation of time and of memory. To the “burning past,” wherein colonized experience is stuck and to which we remain sensitive, is contrasted the colonial construction of white, western time as progressive and futural—a construction (...) that relies on the very indifference, ankylosis, and closure of this time to the multiple, lived temporalities of colonized others. (shrink)

Delusions are often portrayed as paradigmatic instances of incomprehensibility and meaninglessness. Here we investigate the relationship between delusions and meaning from a philosophical perspective, integrating arguments and evidence from cognitive psychology and phenomenological psychopathology. We review some of the empirical and philosophical literature relevant to two claims about delusions and meaning: delusions are meaningful, despite being described as irrational and implausible beliefs; some delusions can also enhance the sense that one’s life is meaningful, supporting agency and creativity in some circumstances. (...) Delusions are not incomprehensible representations of reality. Rather, they can help make sense of one’s unusual experiences and in some circumstances even support one’s endeavours, albeit temporarily and imperfectly. Acknowledging that delusions have meaning and can also give meaning to people’s lives has implications for our understanding of psychotic symptoms and for addressing the stigma associated with psychiatric conditions. (shrink)

Empathy is a topic of continuous debate in the nursing literature. Many argue that empathy is indispensable to effective nursing practice. Yet others argue that nurses should rather rely on sympathy, compassion, or consolation. However, a more troubling disagreement underlies these debates: There’s no consensus on how to define empathy. This lack of consensus is the primary obstacle to a constructive debate over the role and import of empathy in nursing practice. The solution to this problem seems obvious: Nurses need (...) to reach a consensus on the meaning and definition of empathy. But this is easier said than done. Concept analyses, for instance, reveal a profound ambiguity and heterogeneity of the concept of empathy across the nursing literature. Since the term “empathy” is used to refer to a range of perceptual, cognitive, emotional, and behavioral phenomena, the presence of a conceptual ambiguity and heterogeneity is hardly surprising. Our proposal is simple. To move forward, we need to return to the basics. We should develop the concept from the ground up. That is, we should begin by identifying and describing the most fundamental form of empathic experience. Once we identify the most fundamental form of empathy, we will be able to distinguish among the more derivative experiences and behaviors that are addressed by the same name and, ideally, determine the place of these phenomena in the field of nursing. The aim of this article is, consequently, to lay the groundwork for a more coherent concept of empathy and thereby for a more fruitful debate over the role of empathy in nursing. In Part 1, we outline the history of the concept of empathy within nursing, explain why nurses are sometimes warry of adapting concepts from other disciplines, and argue that nurses should distinguish between adapting concepts from applied disciplines and from more theoretical disciplines. In Part 2, we show that the distinction between emotional and cognitive empathy—borrowed from theoretical psychology—has been a major factor in nurses’ negative attitudes toward emotional empathy. We argue, however, that both concepts fail to capture the most fundamental form of empathy. In Part 3, we draw on and present some of the seminal studies of empathy that can be found in the work of phenomenological philosophers including Max Scheler, Edmund Husserl, and Edith Stein. In Part 4, we outline how their understanding of empathy may facilitate current debates about empathy’s role in nursing. (shrink)

Although enactive approaches to cognition vary in terms of their character and scope, all endorse several core claims. The first is that cognition is tied to action. The second is that cognition is composed of more than just in-the-head processes; cognitive activities are externalized via features of our embodiment and in our ecological dealings with the people and things around us. I appeal to these two enactive claims to consider a view called “direct social perception” : the idea that we (...) can sometimes perceive features of other minds directly in the character of their embodiment and environmental interactions. I argue that if DSP is true, we can probably also perceive certain features of mental disorders as well. I draw upon the developmental psychologist Daniel Stern’s notion of “forms of vitality”—largely overlooked in these debates—to develop this idea, and I use autism as a case study. I argue further that an enactive approach to DSP can clarify some ways we play a regulative role in shaping the temporal and phenomenal character of the disorder in question, and it may therefore have practical significance for both the clinical and therapeutic encounter. (shrink)

I discuss Young’s “asymmetrical reciprocity” and apply it to an ethics of mental health care. Due to its emphasis on engaging with others through respectful dialogue in an inclusive manner, asymmetrical reciprocity serves as an appropriate framework for guiding caregivers to interact with their patients and to understand them in a morally responsible and appropriate manner. In Section 1, I define empathy and explain its benefits in the context of mental health care. In Section 2, I discuss two potential problems (...) surrounding empathy: the difficulty of perspectivetaking and “compassion fatigue.” In Section 3, I argue that these issues can be resolved if examined through the lens of an ethics of care. Reciprocal relationships between patients and caregivers are an important element in the development of an ethics of care. In Section 4, I introduce two models of reciprocity that can be applied to a health care context: Benhabib’s symmetrical reciprocity and Young’s asymmetrical reciprocity. In Section 5, I demonstrate how asymmetrical reciprocity cultivates empathy and, in Section 6 and Section 7, I show how it overcomes the objections of empathy and improves therapeutic relationships. (shrink)

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker. Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue (...) that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. (shrink)

The paper discusses two recent approaches to schizophrenia, a phenomenological and a neuroscientific approach, illustrating how new directions in philosophy and cognitive science can elaborate accounts of psychopathologies of the self. It is argued that the notion of the minimal and bodily self underlying these approaches is still limited since it downplays the relevance of social interactions and relations for the formation of a coherent sense of self. These approaches also illustrate that we still lack an account of how 1st (...) and 3rd person observations can fruitfully go together in an embodied account of disorders of the self. Two concepts from enactive cognitive science are introduced, the notions of autonomy and sense-making. Based on these, a new proposal for an enactive approach to psychopathologies of the self is outlined that integrates 1st and 3rd person perspectives, while strongly emphasising the role of social interactions in the formation of self. It is shown how the enactive framework might serve as a basis for an alternative understanding of disorders of the self such as schizophrenia, as a particular form of socially constituted self-organisation. (shrink)

In this paper, I explore some of the temporal structures of racialized experience – what I call racialized time. I draw on the Martiniquan philosopher and psychiatrist Frantz Fanon, in particular his book ‘Black Skin, White Masks,’ in order to ask how racism can be understood as a social pathology which, when internalized or ‘epidermalized,’ may result in aberrations of affect, embodiment and agency that are temporally lived. In this regard, I analyze the racialized experience of coming ‘too late’ to (...) a world predetermined in advance and the distorted relation to possibility – the limitation of playfulness and imaginative variability – that defines this sense of lateness. I argue that the racialization of the past plays a structuring role in such experience. Racialization is not limited to the present, but also colonizes and reconfigures the past, splitting it into a duality of times: one open and civilizational, the other closed, anachronistic and racialized. To understand this colonial construction of the past, I draw on the work of Latin American thinker Aníbal Quijano. (shrink)

This paper seeks to illuminate the nature of empathy by reflecting upon the phenomenology of depression. I propose that depression involves alteration of an aspect of experience that is seldom reflected upon or discussed, thus making it hard to understand. This alteration involves impairment or loss of a capacity for interpersonal relatedness that mutual empathy depends upon. The sufferer thus feels cut off from other people, and may remark on their indifference, hostility or inability to understand. Drawing upon the example (...) of depression, I argue that empathy is not principally a matter of ‘simulating’ another person’s experience. It is better conceived of as a perception-like exploration of others’ experiences that develops progressively through certain styles of interpersonal interaction. (shrink)

The article aims at expanding the horizon of phenomenological psychopathology of depression from a social theoretical perspective. Based on Merleau-Ponty’s phenomenological ontology, in the first section, depression is reinterpreted as a disruption of chiasm: it is not merely the illness of the body, the disorder of the mind, or a specific form of social suffering, but the interrelated distortion of time consciousness, agency, and interaffectivity. The phenomenological clarification of these components provides opportunity for connecting sociological and psychopathological insight. In the (...) second part, contemporary critical theories of acceleration, globalization, biopolitics, and system colonization are reinterpreted to highlight the structural and cultural context of late modern time consciousness, agency, and interaffectivity. In the third section, it is analyzed, how these social constituents shape the space of contemporary socialization processes, including the emergence of those intersubjective distortions, which potentially affect the entirety of chiasm in a depressive way. In the final section, the conclusions for therapy are explored, including the potentials for expanding the epistemological, substantive, and emancipatory horizon of phenomenological psychopathology. (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)

This paper provides a phenomenology of the suicidal process. It begins with an examination of the self and the breaks that occur within the world that the suicidal individual endures. This includes an examination of suicidal hopelessness, termed in this paper as ontological petrification. It follows with the role in which hope plays in the suicidal. The paper then turns to carrying out the action of suicide, including a discussion of the suicide note and the developing form of the suicide (...) note as found in live-streams on social media. The paper concludes by describing the completion of the suicidal process, and the persistence of the suicidal drive in the suicidal individual. The paper makes use of suicide notes, video suicide notes, and stories of suicides. (shrink)

Empathy is a fundamental concept in health care and nursing. In academic literature, it has been primarily defined as a personal ability, act or experience. The relational dimensions of empathy have received far less attention. In our view, individualistic conceptualizations are restricted and do not adequately reflect the practice of empathy in daily care. We argue that a relational conceptualization of empathy contributes to a more realistic, nuanced and deeper understanding of the functions and limitations of empathy in professional care (...) practices. In this article, we explore the relational aspects of empathy, drawing on sources that offer a relational approach, such as the field of care ethics, the phenomenology of Edith Stein and qualitative research into interpersonal and interactive empathy. We analyse the relational aspects of three prevalent components of empathy definitions: the underlying ability or act (i.e. the cognitive, affective and perception abilities that enable empathy); the resulting experience (i.e. empathic understanding and affective responsivity) and the expression of this experience (i.e. empathic expression). Ultimately, we propose four inter‐related understandings of empathy: (a) A co‐creative practice based on the abilities and activities of both the empathizer and the empathee; (b) A fundamentally other‐oriented experience; (c) A dynamic, interactive process in which empathizer and empathee influence each other's experiences; (d) A quality of relationships. (shrink)

Whereas empathy is most often looked upon as a virtue and essential skill in contemporary health care, the relationship to sympathy is more complicated. Empathic approaches that lead to emotional arousal on the part of the health care professional and strong feelings for the individual patient run the risk of becoming unprofessional in nature and having the effect of so-called compassion fatigue or burnout. In this paper I want to show that approaches to empathy in health care that attempt to (...) solve these problems by cutting empathy loose from sympathy—from empathic concern—are mistaken. Instead, I argue, a certain kind of sympathy, which I call professional concern, is a necessary ingredient in good health care. Feeling oneself into the experiences and situation of the patient cannot be pursued without caring for the patient in question if the empathy is going to be successful. Sympathy is not only a thing that empathy makes possible and more or less spontaneously provides a way for but is something that we find at work in connection to empathy itself. In the paper I try to show how empathy is a particular form of emotion in which I feel with, about, and for the other person in developing an interpretation of his predicament. The with and for aspects of the empathy process are typically infused by a sympathy for the person one is empathizing with. Sympathy can be modulated into other ways of feeling with and for the person in the empathy process, but these sympathy-replacement feelings nevertheless always display some form of motivating concern for the target. Such an understanding of empathy is of particular importance for health care and other professions dealing with suffering clients. (shrink)

Contemporary perspectives on delusions offer valuable neuropsychiatric, psychoanalytic, and philosophical explanations of the formation and persistence of delusional phenomena. However, two problems arise. Firstly, these different perspectives offer us an explanation “from the outside”. They pay little attention to the actual personal experiences, and implicitly assume their incomprehensibility. This implicates a questionable validity. Secondly, these perspectives fail to account for two complex phenomena that are inherent to certain delusions, namely double book-keeping and the primary delusional experience. The purpose of this (...) article is to address both problems, by offering an understanding “from the inside”. Our phenomenological approach is a form of “radical empathy”, and crosses the Jaspersian limits of understanding. It compares delusional experiences with variations of reality experience in everyday life, and makes use of the structure of imagination. Six factors influencing the experience of reality are discussed and illustrated by clinical and non-clinical examples. These factors are: continuity, materiality and resistance, multiplicity of sensations and perceptions, intensity, the sense of authorship, and the complex role of intersubjectivity. I suggest that experiences of hypo- and hyperreality are not restricted to pathology, but have their place in everyday life as well. Delusional phenomena can be better understood by investigating the interplay of these six factors. With this framework, the two complex phenomena consequently prove to be better understandable to us. Our approach remains within the phenomenal experience and might thereby contribute to the validity of psychopathology. (shrink)

Under the Mental Capacity Act 2005 (MCA) in England and Wales, the liberal commitments to subjective freedom guide obligations towards persons who do not lack capacity. For the subject of proceedings who might lack capacity (P), it is less clear as to what obligations orient best interests decision-making on their behalf. The UK Supreme Court has emphasised the centrality of ‘P-centricity’ in best interests decision-making, where there is the legal obligation to consider P’s subjective views and wishes in a holistic (...) consideration of best interests. Unclarity nonetheless persists as to what is owed to P in the best interests standard, leading to the tendency to interpret obligations of P-centricity through the normative prism of subjective autonomy. This paper argues that such moves reduce the complex moral phenomenology of what a P-centric ethos entails. Instead, the phenomenological and ethical stance of moral considerability and recognition respect can best capture the enriched normative grounding for P-centric decision-making in mental capacity law. (shrink)

ABSTRACTEmpathy is commonly defined as the ability to feel another person’s emotion, and has previously received significant attention from various research communities. The third-person nature of...

Se aborda de forma crítica la exposición del desorden del espectro autista llevada a cabo en la quinta y última edición del Diagnostic and Statistical Manual of Mental Disorders (DSM-5), herramienta principal de muchos psiquiatras para comprender y diagnosticar cualquier psicopatología. Con este abordaje se busca evidenciar cómo, en el DSM-5 –al igual que en la interpretación inaugurada por Baron-Cohen, Leslie y Frith–, se deja de lado la experiencia y el cuerpo animado del paciente, por lo que es aconsejable un (...) nuevo acercamiento a dicho desorden que tenga fundamentos fenomenológicos. Finalmente, se presenta el bosquejo de una fenomenología del desorden del espectro autista que reconoce la primacía del cuerpo animado en la experiencia del mundo, de sí mismo y de los otros. (shrink)

Se aborda de forma crítica la exposición del desorden del espectro autista llevada a cabo en la quinta y última edición del Diagnostic and Statistical Manual of Mental Disorders, herramienta principal de muchos psiquiatras para comprender y diagnosticar cualquier psicopatología. Con este abordaje se busca evidenciar cómo, en el DSM-5, al igual que en la interpretación inaugurada por Baron-Cohen, Leslie y Frith, se deja de lado la experiencia y el cuerpo animado del paciente, por lo que es aconsejable un nuevo (...) acercamiento a dicho desorden que tenga fundamentos fenomenológicos. Se finaliza presentando un bosquejo de una fenomenología del desorden del espectro autista que reconoce la primacía del cuerpo animado en la experiencia del mundo, de sí mismo y de los otros. (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 centenary of Karl Jaspers' General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work. Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are ‘un-understandable’. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers (...) a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: Is second-order empathy possible? Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices. (shrink)

1. Imagine the following hypothetical scenario: Sarah is often called an expert on depression: after all, she graduated from medical school and has a PhD in neuroscience. She knows all theories of...

In his classic essay “The phenomenological approach to psychopathology”, Karl Jaspers defended the irreducible reality of the “subjective” mental symptoms and stressed the pivotal role of empathy in their diagnostic assessment. However, Jaspers’ account of the epistemological role of empathy in psychopathological diagnosis was far from clear: whereas at several places Jaspers claimed that empathy provides a direct access to patients’ abnormal mental experiences, at other places he stressed that it did so only indirectly, through a whole battery of their (...) observable clinical indicators. The aim of this paper is to reassess Jaspers’ account of the epistemological role of empathy in psychopathological diagnosis. (shrink)

Research in psychopathology is booming in an unprecedented way, at least, in terms of increasing number of publications. Yet, a few questions arise: Does quantity also give us quality? Are the collected data generally of sound quality? How are data typically collected in psychopathology? Are the applied methods of data collection appropriate for this particular field of study? This article explores three different methods of data collection in psychopathology, namely self-rating scales, structured interviews, and semi-structured, phenomenological interviews. To identify the (...) most adequate methodological approach, we first establish the nature of the object of psychopathology and then we critically assess each method’s appropriateness to this field of study. We emphasize fundamental issues that make self-rating scales and structured interviews unfit for the task of adequately examining psychopathology. By contrast, we propose that a semi-structured, phenomenological interview presents a more appropriate method. Finally, we describe two types of semi-structured, phenomenological interviews that can be applied to assess and explore psychopathology, respectively. (shrink)

Research in psychopathology is booming in an unprecedented way, at least, in terms of increasing number of publications. Yet, a few questions arise: Does quantity also give us quality? Are the collected data generally of sound quality? How are data typically collected in psychopathology? Are the applied methods of data collection appropriate for this particular field of study? This article explores three different methods of data collection in psychopathology, namely self-rating scales, structured interviews, and semi-structured, phenomenological interviews. To identify the (...) most adequate methodological approach, we first establish the nature of the object of psychopathology and then we critically assess each method’s appropriateness to this field of study. We emphasize fundamental issues that make self-rating scales and structured interviews unfit for the task of adequately examining psychopathology. By contrast, we propose that a semi-structured, phenomenological interview presents a more appropriate method. Finally, we describe two types of semi-structured, phenomenological interviews that can be applied to assess and explore psychopathology, respectively. (shrink)

This paper outlines several of the challenges that are inherent in any attempt to communicate subjective experience to others, particularly in the context of a clinical interview. It presents the phenomenological interview as a way of effectively responding to these challenges, which may be especially important when attempting to understand the profound experiential transformations that take place in schizophrenia. Features of language experience in schizophrenia—including changes in interpersonal orientation, a sense of the arbitrariness of language, and a desire for faithful (...) communication of experience —are described, together with discussion of their relevance for the interview context. Furthermore, the interview presents a unique context in which both intersubjective and interpersonal aspects of experience will be described as well as evoked. It is proposed that phenomenological interviewers should not only be familiar with these and other experiences that can occur in schizophrenia, but also capable of applying the techniques of phenomenological and hermeneutic methods in order to understand the descriptions of interviewees with sensitivity and accuracy. (shrink)

A phenomenological insight in the debate on empathy is that it is possible to directly perceive other people’s emotions in their expressive bodily behaviour. Contrary to what is suggested by many phenomenologists, namely that this perceptual skill is immediately available if one has vision, this paper argues that the perceptual skill for empathy is acquired. Such a skill requires that we have undergone certain emotional experiences ourselves and that we have had the experience of seeing the world differently, which is (...) a form of pretence. By investigating how we retain knowledge of what is real while pretending, that is, how we anchor the experience of pretence in something that is not pretended, the paper argues that we split our experiential perspective into a double perspective, which differs from the cognitive act of understanding what a perspective is. With this notion in hand, we can return to the debate on empathy. It is argued that in order to have the capacity for direct empathic perception, one must have undergone experiences involving a double perspective. (shrink)

A large amount of research in mental health care relates to the notion of trust, as a possible common factor in psychopathology, and as a common dimension of psychotherapeutic alliance, underlying the various therapeutic methods. Such hypotheses call for a more detailed analysis of this notion of trust. The paper seeks to shed light on this issue by confronting the clinical and phenomenological approaches. We propose to focus on three issues at stake: 1/ the issue of the existence of a (...) tacit or pre-reflective trust, which can be defined by a phenomenological method. 2/ the issue of a foundation of trust in empathy, which questions the debates about empathy in phenomenological works. 3/ the issue of a structural self-opacity, brought to light through the paradoxical structure of trust, and that we propose to tackle with the notions of attestation and narrative identity. (shrink)

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)

Summary This paper presents and contextualizes the construct of Aesthetic Relational Knowing (ARK), as the intuitive experience of the therapist that emerges from the phenomenological field created in a meeting between therapist and client. The concept of isomorphism is considered as an epistemological turning point and a possible bridge connecting Gestalt therapy, Gestalt theory and Neurosciences. An example of the clinical consequences of this change of perspective is given. Moreover, a validation pilot study has shown that ARK is described by (...) three factors: empathy, resonance and bodily awareness. The ARK can be defined as a three-dimensional construct that supports the positive use of the therapist’s perception in terms of aesthetic knowing of the phenomenological field of the therapeutic situation. The construct of Aesthetic Relational Knowing can be considered a phenomenological, aesthetic and field-oriented contribution to psychotherapy training, supervision and research. (shrink)

ABSTRACTThis paper brings together a phenomenological and vulnerability-theoretic approach to dementia. The paper challenges the view that subjects with dementia can simply be understood in terms of diminished cognitive capacities or that they have lost all vestiges of personhood or the capacity for meaningful interaction. Instead, drawing on vulnerability theory and the phenomenological work of Kristin Zeiler and Lisa Käll, an alternative view of persons with dementia is offered that is based on intersubjective and intercorporeal relations and accomplishments. A vulnerability (...) approach to dementia is developed that not only provides the basis for empathetic responses to illnesses such as dementia but also points to the intersubjective constitution of subjects more generally. The argument developed is that the notion of vulnerability designates a form of openness to others and that such openness is a precondition for empathy. (shrink)

Patients’ experience of symptoms does not follow the body–mind divide that characterizes the classification of disease in the health care system. Therefore, understanding patients in their entirety rather than in parts demands a different theoretical approach. Attempts have been made to formulate such approaches but many of these, such as the biopsychosocial model, are still basically dualistic or methodologically reductionist. In primary care, patients often present with diffuse symptoms, making primary care the ideal environment for understanding patients’ undifferentiated symptoms and (...) disease patterns which could readily fit both bodily and mental categories. In this article we discuss theoretical models that have attempted to overcome this challenge: The psychosomatic approach could be called holistic in the sense of taking an anti-dualistic stance. Primary care theorists have formulated integrative views but these have not gained a foothold in primary care medicine. McWhinney introduced a new metaphor, ‘the body–mind’, and Rudebeck advocated cultivating ‘bodily empathy’. These views have much in common with both phenomenological thinking and mentalization, a psychological concept for understanding others. In the process of understanding patients there is a need for the physician to enter an intersubjectivity that aims at understanding the patient’s experiences and sensations without initially jumping to diagnostic conclusions or into a division into mental and physical phenomena. Mentalization theory could form the basis of an approach to a more comprehensive understanding of patients. The success of such an approach is, however, dependent upon structural and organizational conditions that do not counteract it. (shrink)

In this article, I argue that the recent emphasis on compassion in healthcare practice lacks conceptual richness and clarity. In particular, I argue that it would be helpful to focus on a larger concept of empathy rather than compassion alone and that compassion should be thought of as a component of this larger concept of empathy. The first part of the article outlines a critique of the current discourse of compassion on three grounds. This discourse naturalizes, individualizes, and reifies compassion (...) leading to a decontextualized and simplified understanding of failures in healthcare practice. The second part uses resources from phenomenology and contemporary moral philosophy to construct a “hybrid” concept of empathy that includes both pre‐reflective/intuitive and cognitive/imaginative components. This “hybrid” concept of empathy leads to a more complex understanding of the multiple responses to others' distress. I conclude that there are no straightforward normative naturalistic responses to others' distress. Rather than conceptualizing compassion as a naturalistic impulse or a character‐based trait, we need to consider the complexity of our empathic recognition of vulnerable others. (shrink)

Throughout the years, care ethicists have raised concerns that prevalent definitions of empathy fail to adequately address the problem of otherness. They have proposed alternative conceptualizations of empathy that aim to acknowledge individual differences, help to extend care beyond one’s inner circle, and develop a critical awareness of biases and prejudices. We explore three such alternatives: Noddings’ concept of engrossment, Meyers’ account of broad empathy, and Baart’s concept of perspective-shifting. Based on these accounts, we explain that care ethics promotes a (...) conceptualization of empathy that is radical in its commitment to engage otherness and that is characterized by being: (1) receptive and open, (2) broad and deep in scope, (3) relational and interactive, (4) mature and multifaceted, (5) critical and reflective, (6) disruptive and transformative. This type of empathy is both demanding and rewarding, as it may inspire health professionals to rethink empathy, its challenges, and its contribution to good care and as it may enrich empathy education and professional empathy practices in health care. (shrink)

Western philosophy has asserted that in order to be a person, one must be rational. This idea was not challenged until the nineteenth century. One school to challenge this notion was phenomenology, which asserted that what made one a person was their ability to empathize. While the founder of the school, Edmund Husserl, did not assert that the ability to decipher nonverbal cues was necessary in order to empathize, several of his followers did. This emphasis on deciphering nonverbal cues proved (...) problematic for some populations, especially the Autistic. Autism is a neurological condition which makes it difficult to decipher nonverbal cues. Because of this, Autistic people are accused of lacking empathy. This is especially problematic in the case of women. Scholars such as Simon Baron-Cohen argue that on average, women are more empathetic than men. If one lacks empathy, then one has an extreme male brain. The extreme male brain is called Autism. Hence, even if an Autistic person identifies as female, her femininity is in question due to her having a male brain. If phenomenology argues that the person is shaped by their ability to empathize, then there must be a way to account for the experiences of Autistic women. In order for phenomenology to account for empathy, there must be a theory which can account for breakdowns in empathy, can critique current therapies which force the Autistic person to pass as non-Autistic, and must provide the Autistic woman a path to being authentically herself. One such theory is that proposed by Martin Heidegger. Heidegger argues that being-with-others is vital for one to be a Dasein. Still, Others can press upon Dasein to conform to their standards. The pressure to conform can lead Dasein to forget who she is. In order to be authentic, Dasein must go through the process of anxiety, after which she can become authentically herself. Thus, Heidegger’s theory gives women a path in which they can share their experiences, thus providing necessary insights to philosophy, psychology and sociology. (shrink)

Ecology of the Brain: The Phenomenology and Biology of the Embodied Mind joins a growing body of writings which presents a serious and compelling challenge to the neuro-centrism and physicalist reductionism that has been predominant in recent philosophy of mind and in the human sciences. This volume will not only be relevant to researchers interested in the philosophy of mind and the role to be played by the human sciences in this domain, but it will also be a valuable addition (...) to any psychiatric training program. It complements the pioneering work of Karl Jaspers and offers a much needed antidote to the explicit or implicit Cartesianism and physicalist reductionism that still persists in many psychiatric writings, research programs and approaches to clinical practice. As Fuchs alerts, the failure to appreciate the organism’s or individual’s embeddedness in an environment, in a world, has stymied efforts to advance psychiatric theory and practice and we can also say this failure has contributed to the current crisis in legitimacy of psychiatry (Daly and Gallagher, 2019). Despite hopes and ambitions that neuroscience might rescue psychiatry from this crisis, it is increasingly clear that it cannot deliver on this promise as long as researchers and clinicians ignore the life-world (das Umwelt) and neglect the concept of life itself as Fuchs proposes. An ecological approach to understanding the brain is thus crucial so as to address these deficiencies. Fuchs acknowledges the previous articulation of a compatible view in the work of Gregory Bateson’s, Steps to an Ecology of the Mind (1972). While Bateson draws on anthropology and evolutionary theory, Fuchs draws on the resources of phenomenology and neurobiology. Fuchs offers integrated analyses of ideas not only from Bateson, but also from the classic phenomenological sources of Husserl, Jaspers and Merleau-Ponty, and brings these ideas into engagement with current neuroscience, psychological medicine, psychiatric theory and practice. (shrink)

In this paper, I wish to explore the contribution of the phenomenological reduction to a distinct form of empathy, which has been identified and called by Ratcliffe :473–495, 2012) radical empathy. This form of empathy brings to light the sense of reality experienced by the subject rather than a mere mental state. However, I shall consider whether and how the phenomenological reduction allows different interpretations of the same experience, thereby impacting on our understanding of another’s sense of reality. Far from (...) dismissing the role of the reduction, I propose a reconsideration of its relevance for radical empathy. In order to spell out my argument, I propose a case ex negativo that looks at Sartre’s and Merleau-Ponty’s different analyses of the sense of reality experienced by obsessive patients. I argue that this interpretative difference ultimately depends on two opposite uses of the reduction itself, and that Merleau-Ponty’s account offers a promising perspective to reintegrate and contextualize the phenomenological reduction into radical empathy. (shrink)

This article investigates elements of empathy in the Zhuangzi 莊子. It outlines four prominent aspects of current scholarship on empathy: different types of empathy, the other-centeredness of empathy, empathy as a process and the role empathy plays in responsiveness to others, and interaction between empathy and other capacities. Based on materials from the Zhuangzi that involve elements of empathy, I delegate them respectively to these four areas. While the Zhuangzi does not invent any specific term for an exclusive designation of (...) the meaning of empathy, I attempt to show that the Zhuangzi does explore the phenomena of empathy to a great extent. It characterizes unique features of empathy, such as other-centeredness, perceptual directness, its function as listening, mirroring, qi 氣-connecting and receptivity, the issue of how to cultivate one’s empathic capacity in the everyday encounter with others, and especially how empathic capacity works closely with the Zhuangzian forgetfulness of oneself. (shrink)