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Prof. Thomas Fuchs

 

Thomas Fuchs Controversias Psiquiatria Barcelona
Talk The crisis of psychiatric diagnostics and the role of phenomenological psychopathology
Date Friday, April 21st, 2017
Time 09:00 - 09:45

 
BIOGRAPHY

Head of the Research Section "Phenomenological Psychopathology and Psychotherapy"
Chairman of the Section "Philosophical Foundations of Psychiatry " of the German Psychiatric Association (DGPPN)
Fellow of the Marsilius-Kolleg (Center for Advanced Interdisciplinary Studies, University of Heidelberg)
Director of the Interdisciplinary Forum for Biomedicine and the Humanities (IFBK), University of Heidelberg
Coordinator of the European Marie-Curie Research Training Network "TESIS – Towards an Embodied Science of Intersubjectivity " (www.tesis-itn.eu), 2011-2015, including 7 European Centers from philosophy, neuroscience, psychiatry and developmental psychology
Coordinator of the Heidelberg Excellence Project "Embodiment, anthropology and culture " (www.marsilius-kolleg.uni-heidelberg.de)
Co-Editor "Psychopathology ". International Journal of Descriptive and Experimental Psychopathology, Phenomenology and Psychiatric Diagnosis. (www.karger.com/Journal/Home/224276)

Major Research Areas
- Phenomenology and cognitive neuroscience
- History and ethics of medicine and psychiatry

 
ABSTRACT

The establishment of criteriological diagnostic systems since the 1980ies has increased the reliability of psychiatric diagnosis. On the other hand, the limits of this approach for clinicians and researchers are becoming increasingly apparent. DSM V and ICD 10, with their epistemological roots in logical positivism, are mainly conceived for purposes of reliability, and therefore characterized by rather simple psychopathological concepts compatible with easily applicable data collection techniques. Consciousness and subjectivity, however, are virtually excluded on the theoretical level and undervalued on the pragmatic level, with serious consequences for the validity of psychiatric diagnosis, for empirical research and, above all, for therapeutic purposes. The resulting crisis of psychiatric diagnostics and decline of psychopathological expertise has been deplored by leading psychiatrists. It might even be ag-gravated by recent suggestions to rebuild psychopathology on functional, neurobiologically based Research Domain Criteria (RDoC).

In order to propose a way out of the crisis, I will first distinguish three major ap-proaches to the assessment of mental illness:
1. The positivistic, objectifying or 3rd-person approach as endorsed by DSM IV and ICD 10, focusing mainly on observable behavioural symptoms;
2. The phenomenological, subject-oriented or 1st-person approach, fo-cusing on the patient's conscious self-experience and exploring its basic, often implicit structures;
3. The hermeneutic, intersubjective or 2nd-person approach, mainly aiming at the co-construction of shared narratives or interpretations regarding the patient's self-concept, conflicts and relationships, as e.g. in psychodynamic approaches.

Among these, I will particularly elaborate upon the phenomenological approach which uses in-depth analyses of the patient's self-experience, thus explicating its basic structures such as self-awareness, identity, embodiment, temporality, intentionality and intersubjectivity. Here, symptoms are not identified in isola-tion, but always in relation to the subject and the whole of conscious experience in which these symptoms emerge. What phenomenology is looking for are the "psychopathological organizers" or fundamental patterns that connect the single features – for example, affective depersonalisation in melancholic depression or autism in schizophrenia. It aims at the typification, that means, the recognition of prototypes of mental disturbances, for which thorough single case studies may be of particular importance. Once captured by phenomenological analysis, the typical features of a disorder may also provide a basis for the development of more standardized assessment instruments, examples of which will be presented.

The talk will compare and discuss the above mentioned different approaches to diagnosis and psychopathology. It will argue that subjectivity and intersubjectivity remain indispensable aspects of a thorough psychiatric assessment and valid classification, which is also necessary for sound neuroscientific research.

 
REFERENCES

[PDF] Fuchs, F.; Schlimmeb, JE (2009). Embodiment and psychopathology: a phenomenological perspectivey. Curr Opin Psychiatry 2009; 22:570–575.

[PDF] Fuchs, F. (2010). Subjectivity and Intersubjectivity in Psychiatric Diagnosis. Psychopathology 2010;43:268–274 DOI: 10.1159/000315126.

[PDF] Fuchs, F. (2010). Phenomenology and Psychopathology. D. Schmicking and S. Gallagher (eds.), Handbook of Phenomenology and Cognitive Science, DOI 10.1007/978-90-481-2646-0_28.

[PDF] Fuchs, F. (2013). Depression, Intercorporeality, and Interaffectivity. Journal of Consciousness Studies, 20, No. 7–8, 2013, pp. 219–38.