A Step Beyond Psychopathology: A New Frontier of

Phenomenology in Psychiatry

Melissa Garcia Tamelini, Guilherme Peres Messas

Philosophy, Psychiatry, & Psychology, Volume 26, Number 2, June 2019,

pp. 151-154 (Article)

Published by Johns Hopkins University Press

DOI: https://doi.org/10.1353/ppp.2019.0020

For additional information about this article

https://muse.jhu.edu/article/727348

Access provided at 29 Sep 2019 19:39 GMT from USP-Universidade de São Paulo
 A Step Beyond
Psychopathology
A New Frontier of
Phenomenology
in Psychiatry
C
ritical-philosophical commentary on
theses defended in scientific articles may
be guided by two distinct perspectives,
each leading to inquiries and styles of responses
that are both distinct and complementary: an
internal perspective and an external perspective.
The internal commentator belongs to the same
epistemological field of the authors and, as such,
shares the same categorical assumptions and the
same Weltanschauung explored in the text. The
dialogue with this commentator emphasizes the
minutiae of the observation of the shared scien-
tific reality and points out the frontiers toward
which the discussion of a scientific branch must
advance. The external commentator, in contrast,
emphasizes the categorical contrasts and semantic
differences between the scientific field to which
this commentator belongs and the one to which
the authors belong. Their inquiries summon the
authors to an explanation of their concepts. The
valuable comments of Daker and Dalgalarrondo
to the article “Principles for pharmacological treat-
ment of schizophrenia in light of phenomenologi-
cal psychopathology” correspond with internal
and external criticisms, respectively. Both allow
© 2019 by Johns Hopkins University Press
Melissa Garcia Tamelini &
Guilherme Peres Messas
key points in the proposed discussion to receive
further clarification.
Before trying to reflect on some aspects raised by
the commentators, additional notes are addressed.
We share the position that “to consider phenom-
enology as a purely descriptive science of the way
the world appears to be experiencing subject is a
serious misunderstanding” (Stanghellini, 2011,
p. 29) and that it is the task of psychopathology
itself to expand its notorious relevance to clinical
practice (Mullen, 2006). However, the transposi-
tion of scientific findings from phenomenological
psychopathology to psychiatric practice is still a
subject of debate in the contemporary literature.
Despite the obvious complexity involved in the
dialogue between psychopathology and empirical
studies, our contribution to this volume of the PPP
aims precisely at endorsing the view that critical
appreciation of clinical care is the next frontier
of the phenomenological research agenda in psy-
chiatry. We believe that a phenomenologically
guided therapy is a doable and desirable prag-
matic attempt “not only because of the historical
legacy of phenomenology but above all its living
potential to deal with the dilemmas and challenges
152  ■  PPP / Vol. 26, No. 2 / June 2019
still in force in psychiatry today.” Recent studies
begin to propose hypotheses in this direction, in
line with the understanding that “core insights
into the disorder result as well as core treatment
implications” (Moskalewicz & Schwartz, 2018,
p. 8). In other words, our aim is to broaden the
scope of epistemological foundations already
rooted in the psychiatric tradition, but still largely
unexplored. This general ambition can only be
presented by way of a very restricted example, in
this case, a specific property of the antipsychotics
in schizophrenia. Without the explanation of the
thesis, by means of examples, the article would be
no more than an empty manifesto. On the other
hand, the presentation of a single example means
in itself the possibility of exploring an investigative
path, justifying the evocation of a reform of the
psychiatric therapeutic agenda.
Let us turn to the answers to some of the ques-
tions raised, beginning with internal criticism.
Daker pertinently inquires: “How weight gain
in the living body could lead to a change in the
pre-reflexive structure of corporeality?” (p. 144).
As the commentator himself explains, there is a
common phenomenological distinction, although
permeated by ambiguities and heterogeneity in the
philosophical and psychopathological literature
(Fernandez, 2016), between the lived body (Leib)
and the corporeal body (Koerper). These two di-
mensions constitute the body, which is “a form of
subject-object, neither purely that which perceives,
nor which is perceived, but constantly both”
(Bowden, 2012, p. 231). Regarding the Leib/
Koerper polarity, however, it is important to note
that taking the corporeal body as a “foreign body
in the original life-world of prereflective experi-
ence” (Fuchs, 2002, p. 224) would only replace the
classic mind–body dualism. And if, under normal
conditions, “an ongoing oscillation between these
two bodily modes constitutes a fluid and hardly
noticed foundation of all experiencing” (Fuchs
& Schlimme, 2009, p. 571), in psychopathologi-
cal contexts, this dialectical balance is modified.
In phenomenological terms, schizophrenia is a
particular kind of severe modifications of con-
sciousness, which can be considered as an ipseity
disturbance (Sass & Parnas, 2003). Specifically in
relation to embodiment, contemporary authors
consider that there is a fundamental modifica-
tion of the lived body or a “disembodiment of
the self” (Fuchs & Schlimme, 2009). It is in the
face of these exceptional conditions prevailing in
consciousness that we must consider the potential
role of the corporeal body in schizophrenia. Fuchs
(2002) points out that this dimension of the body
“appears whenever a reaction or resistance arises
to the primary performance of the lived-body”
(p. 225). In this context of self-disturbances
(Sass & Parnas, 2003, 2010), a prominence of
some corporeality experience could “guarantee a
primary point of articulation in the experiential
field, since being a body is to be already necessarily
connected to a world.” In other words, given the
schizophrenic disturbance, the body’s experience
of solidity and heaviness or even the substantiality
of having a body (Mishara, 2005) would be pos-
sibilities for the reestablishment of a basic sense of
self. It should be clear that we are not suggesting
that the recovery objectified by the use of antipsy-
chotics is the mere weight gain, but rather that
the set of empirical data and psychopathological
finding points to the relevance of this dimension
for the understanding and for the development
of therapeutic strategies in schizophrenia. In this
concern, the investigations should be continued to
better specify the differences between the available
treatment modalities, their limitations, and their
specific indications.
Regarding Dalgalarrondo’s comments, his criti-
cisms are a rich example of the plurality of views
that constitute psychiatry (Marková & Berrios,
2012), offering a unique opportunity to highlight
the fundamental differences between a semio-
logical psychopathology and a phenomenological
psychopathology. These differences go beyond a
categorical and semantic variation, but, as we will
briefly indicate in some of the points raised, they
reveal different worldviews.
Dalgalorrondo cites the multiplicity of voices
within phenomenology and asks about the pos-
sibility of a factual convergence of the phenomeno-
logically informed discussion of schizophrenia: we
agree with him, because there is neither a singular
meaning of phenomenological psychopathology,
nor an essential notion capable of satisfactorily
summarizing the entire phenomenological un-
 Garcia Tamelini & Peres Messas / A Step Beyond Psychopathology  ■ 153
derstanding of the schizophrenic condition. In
relation to this absence of factual convergence,
Sass says by mentioning three leading names in
the phenomenological tradition:
There are obviously many differences between
Minkowski, Blankenburg, and Kimura – differ-
ences of style and intellectual approach as well
as in their preferred ways of describing schizo-
phrenia. But it would be a mistake to let these
differences obscure the affinities that link these
approaches together and allow them to compose
a reasonably coherent vision of schizophrenic
disorders. (Sass, 2001, p. 266)
From another angle, we may also say that the
conceptual diversity of psychopathology reveals
the impossibility of an integral observation of
schizophrenia, a condition that continues to
challenge any attempt at simplification and reduc-
tions. Moreover, the search for such convergence
seems to be better understood as an aspiration of
another epistemological paradigm, neopositivism,
which seeks a universal and definitive validity in
psychopathology.
In relation to the notes on delusion, the discus-
sion around this phenomenon is quite illustrative
of the methodological differences that support the
findings of semiology, descriptive psychopathology
and phenomenological psychopathology. Dalg-
alarrondo states that “delusion does not have a
restorative effect, but has indeed severe disturbing
consequences, hindering or even destructing life
projects and overtures or viable existential roads”
(p. 149). We agree on the “existential price” that
accompanies the emergence of delusion in schizo-
phrenia, but this finding only seems contradictory
to a restorative effect if we focus exclusively on the
semiological or descriptive scope. Phenomenology
investigates delusion as a phenomenon that is one
among the radical disturbances in the conscious-
ness, “as a mutation of the ontological framework
of experience itself” (Sass & Pienkos, 2013, p.
633). The restorative effect of this phenomenon
concerns to the formal possibilities contained
within this primary schizophrenic modification
(such as the fragmentation of the perceptual field
and a disintegration of corporeal anchorage) and
may be revealed in many aspects (Sass & Pienkos,
2013), among them as an alternative “to restore
[ . . . ] a commonsensical reality” (Fuchs, 2015, p.
179). In relation to Dalgalarrondo’s considerations
regarding the effects of antipsychotics, we would
like to point out two aspects. First, the distinc-
tion between positive and negative symptoms
and the current notion that antipsychotics have
as their site of action the symptoms of the first
group also reflect tendencies toward reductionism
(Sass, 2003), which are not peculiar to the field
of phenomenology. Second, it is only in view of
the phenomenological distinctions of embodiment
briefly mentioned that the therapeutic property
postulated for the antipsychotics can be taken
into account.
Finally, a brief consideration of the notion of
anthropology. As a philosophy of human life,
anthropology is one of the fundamental branches
of philosophy. However, the independence of
psychopathology in relation to philosophy reduces
the multiplicity of meanings of the word, carrying
the term, originally linked to a series of authors
with philosophical intentions (pointed out by
Dalgalarrondo) to a group of psychopathologists
and clinicians with specific empirical interests and
duties: the construction of a therapy that takes
into account the totality of the human experience.
Because psychopathology as an empirical science is
independent of philosophy, it should be considered
that the adjective “anthropological,” by appearing
alongside others of great reputation in the history
of clinical practice, such as “psychoanalytic” or
“behavioral” may, in full right, be associated with
psychiatry, making it a classic subtype of this spe-
cialty, anthropological psychiatry.
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