Parallel Sessions - Launch Event

Traditional descriptive approaches to psychopathology take, as their point of departure, delusional assertions: that is, the act of stating the proposition that the speaker represents as true. Separated from the ongoing process of narration, the delusional proposition is analysed as a discrete unit of language with doxastic commitments. This is true both for quantitative methods but also for widely used qualitative methods involving categorisation. 

I argue that, while these approaches have some useful applications, their uncriticised acceptance as the only way of accessing delusional phenomena is highly problematic insofar as it is permeated by a monologic philosophy of language and perpetuates essentialist thinking in psychiatry: the properties of a certain “delusion” as conveyed by an individual’s speech exist independently of the experiential, historical, institutional and interactional contexts within which the phenomenon is constituted as such.

In addressing this problem, I challenge a set of questionable assumptions: 1) That the speaker has a clear grasp of what they wish to communicate; qualitative studies of delusions show that uncertainty often prevails. 2) That the speaker is operating within a logico-scientific mode of thought regulated by requirements of logical proof, consistency, and noncontradiction; most if not all narratives do not fulfill these ideals. 3) That the speaker is operating within a linear clock-model of time; just like mystery stories, at least some delusional narratives seem to be governed as a whole by their way of ending.

As an alternative, I propose a novel interdisciplinary corrective combining methods from phenomenology and linguistics. Using narrative inquiry as the point of entry, this approach privileges the centrality of the person and their storied life as a way to uncover the conditions that give rise to delusional phenomena, the context in which they are embedded, the interactional dynamics that shape them, and their consequences for self-understanding. 

The eating disorder anorexia nervosa is often regarded as a disorder of thinness, or distortion of one’s body image – an attempt to lose weight that has gone radically wrong. Yet, those with lived experience of anorexia emphasise that their disorder is not about weight loss or food, but a meaningful response to disruptions of their subjective and affective bodily experience. Phenomenologists have recently drawn on theories of embodiment, particularly those of Maurice Merleau-Ponty, to offer accounts of anorexia nervosa that are attentive to these experiences and move away from a body image distortion model of the disorder (e.g., Bowden 2012, Legrand 2013). Starting from Fredrik Svenaeus’ (2013) suggestion that anorexia involves an experience of ‘unhomelikeness’ as well as Lucy Osler’s (2021) proposal that anorexia is a ´radical project of bodily control´, I argue that anorexia is also taken up as a project of making the body home again. Drawing on a critical, feminist analysis of home, I argue that the lived habitual body presented in Merleau-Ponty´s work is also a ´home-body’ characterised by experiences of autonomy, familiarity, safety, intimacy, and ease. This affective character of the body is disrupted or lost for those with anorexia, and I argue that anorexic practices are attempts at re-establishing it. However, as Osler (2021) points out, anorexia is a disorder of stages and anorexic practices over time intensify the alienation from the body. It is, in this way, a self-defeating project. This account ultimately shows that a focus on body image distortion in anorexia offers an overly static, reductive, and paradoxical picture of the disorder. This has implications for a pluralistic approach to the treatment of anorexia, which attends to the embodiment of the individual.

Mental health laws provide the backdrop against which society understands and reacts to an individual’s experience of psychosis. The Mental Capacity Act 2005 sets out the framework for assessing a person’s decision-making capacity in all aspects of life and what should follow if they are found to not be able to make decisions. As such, they do then affect an individual’s wider experience of life with psychosis. But that is separate from the initial, experience of the phenomenon of psychosis itself. This paper asks what, if any, is the role of that initial lived experience in any decision-making processes that need to happen. Is there space in the legal framework for that subjective viewpoint to be given meaning, and if so, where?

I am particularly interested in how the court has approached the question of centring P in best interest decisions when combined with a person’s experience of psychosis. I explore the question of the subjectivity of best interests within a wider philosophical context of the phenomenology of neurodiversity as well as wider questions of the valuing of "othered" disabled life.

That is what this paper is concerned with, it asks what is it like to live with psychosis and does this have any legal weight. When you, personally, are having an odd experience, it does not immediately matter how other people decide to refer to it. It matters, but only because there are complex societal effects that depend on which label is applied. To answer all these questions, I argue that a phenomenological approach is essential. When dealing with what the law says and means, one can be analytic, but to get to the crux of what it means to exist within mental illness, it is necessary to make use of existential and phenomenological philosophical tradition.

I present here the argument that diminished agency, from the perspective of the lived experience of the individual with a mental disorder, should not be a demarcation criteria for psychopathology.

Much work has been done order to understand the nature of mental disorder under the unifying enactivist framework (Di Paolo, 2005; Maiese 2022; see also Slaby, Paskaleva and Stephan 2013; de Haan 2020; Nielsen 2020). From the enactive perspective, mental disorder arises when an individual’s capacity to functionally interact with the environment is compromised, and as such they are unable to maintain them as autonomous, adaptive and autopoietic organisms. Lack of, or diminished agency, appears to be, at the very least, a necessary condition for naturalist, enactive conceptions of disorder.

I argue, however, that such enactive accounts, while correctly identifying a very common strand of diminished agency felt by people with mental disorders, fail to account for the experiences of agency we see in Mad Studies (see Cantón 2022). In such cases, individuals see their pathological experience as opportunities for growth and learning. Enactive accounts, therefore, provide a one-dimensional view of how agency is transformed in mental disorder that is both inaccurate and may result in hermeneutical injustice (Ritunnano 2022).

I support this proposal by examining experiences of agency through the lens of mindshaping (Andrews 2015; McGeer 2007, 2015; Mameli 2001; Zawidzki 2008, 2016). On this account, self-interpretations can become loaded with different expectations, which actively shapes what we see as possibilities for action in the world. I suggest that experiences of agency in mental disorder are shaped by such norm-laden self-interpretations which inform what someone perceives to be able to do for a person like them. From this perspective, we can better understand how a person’s experience in mental disorder may not always be of diminished agency.

The understanding of the First-episode psychosis (FEP) from the perspective of Basic-Self Disorder (BSD) has allowed an advance in the research of this phenomena. One of the reasons is that it approaches a core element of Schizophrenia Spectrum Disorders (SSD) that appear in an earlier stage comparing to psychotic symptoms; and it is more distinctive than other behavioral prodromes, that can be very similar in other disorders. But there are still some experiences that still offer challenges in the differential diagnoses of FEP. The Dissociative Disorders (DD) are especially easy to be confused in first episodes because of the experience of derealization, depersonalization and of hearing voices. This difficulty in delimiting the differences between the two pathologies occurs especially in their early stages, when symptoms and prodromes are polymorphic and overlap. This ongoing research aims to investigate the Anomalous Self-Experiences (ASE) in FEP, comparing and differentiating SSD and DD. These lived experiences will be apprehended through interviews that will use the Examination of Anomalous Self-Experience (EASE) and the Examination of Anomalous World Experience (EAWE).  The hypothesis of this research is that there are important differences between these experiences, in SSD there are more distinctive characteristics of confusion between self and world and diminishing of the first-person perspective, even in early stages, than in DD. Analysis will be based on dialectical-proportional phenomenological psychopathology and will intend to describe the style of the structure of consciousness in each case. It is expected that the comprehension of ASEs in these two comparative contexts will refine and enlarge upon existing descriptions of the FEP and allow a better adaptation of clinical early interventions.

Psychiatrists live and work in complex, clinically challenging times. Their paperwork is geared increasingly towards defensive practice, key performance indicators and risk assessment forms. Somewhere in the process, detailed understanding of patient experience and clinical formulation based on key psychiatric expertise and skill in mental state examination have taken a backseat. I review the history behind the Present State Examination, the realisation in the 1980s of the need for a common psychiatric language internationally and the current position on phenomenology in psychiatry curricula in the UK. I conclude that it is time to think seriously about a return to basics in psychiatric phenomenology and psychopathology.

During the presentation I would also like to present perspectives from personal clinical and teaching experiences from 3 continents. I have been fortunate to have first-hand experience in several countries. My paper has focused on the history of PSE which has a foundation in trying to bring a common language to psychiatry across the world. I would like to discuss whether this is clinically possible and touch upon the debate of putting forward a single phenomenological approach for the world. Do western concepts dominate the world, stifling cultural angles or is it really possible to have a single phenomenological language?

The concept of paraphrenia emerged in the work of Kahlbaum (1828-1899), being classified among the dementias, which would later be restructured by Kraepelin (1856-1926). Until then, paraphrenias were included in the conceptions of dementia praecox or paranoia. The Kraepelinian descriptions refer to a group with several points in common with dementia praecox, but in which the internal harmony of psychic life is considerably less affected or, at least, limited to certain intellectual faculties, without the occurrence of intellectual deterioration, visual hallucinations, incoherence, marked loss of associations, flattened or markedly inappropriate affects, or grossly disorganized behavior. Since then, the concept of schizophrenia created by Eugene Bleuler (1857-1939) replaced the Kraepelinian perspective, the evolutionary criteria of dementia praecox, with a hierarchical symptomatic appreciation. This model has been widely adopted by contemporary psychiatric literature (ICD-10 and DSM-V) categorizing the group - broad, heterogeneous and increasingly inflated - of schizophrenia. This group presents marked imprecision and limits that are too comprehensive, being insufficient for both clinical and research purposes, since they include cases with completely different initial presentation, prognosis and therapeutic response. The contribution of a historical and epistemological appreciation, in this sense, appears as an important instrument to clarify and contextualize these insufficiencies, legitimizing the search for more adequate concepts for psychiatric activity. Our aim in this presentation is to elaborate the classical concept of paraphrenia under a phenomenological psychopathological perspective. We intend to show how the current categories of phenomenological psychopathology may add clarity to the classical original conception, and, in addition, we will explore the possible advantages for clinical care and science of the renewing the concept of paraphrenia through phenomenological lenses.

The whole field of mental health is in crisis. The scarcity of relevant scientific results and the absence of a positive impact on public health after decades of hegemony of the neuroscientific model of understanding mental disorders has been opening space for new paradigms to be called for. Among these, the phenomenological paradigm is one that has been concentrating the hopes of the scientific literature. The question, therefore, is: can the phenomenological worldview, scientifically centered on the discipline of "phenomenological psychopathology" (PhP), fulfill this major role of renewing the field of mental health? Phenomenological psychopathology is a discipline that has a century-old history, alternating moments of greater influence on the field of mental health with periods of near irrelevance. The purpose of this presentation is to investigate historically the reasons why the value of PhP has fluctuated in this way. I intend to investigate the issue from three perspectives: a) the social-scientific context of PhP's emergence or prominence, b) the characteristics of the responses and proposals it offered to these contexts, and c) the weaknesses of these responses, which favored its decline. To develop my argument, I will consider three great periods of the phenomenological movement in psychopathology, which I will call: 1. the inaugural moment: classical psychopathology; 2. the countercultural moment; and 3. the neuroscientific epistemological moment. There is considerable overlaping between these periods. I believe that through the knowledge of the gains and weaknesses of these moments and, above all, through the awareness of their meanings in each historical context, we can be in a better position to qualify the present moment, of renewal of PhP, to effectively lead a new paradigm for the entire field of mental health. Avoiding the mistakes of history is crucial for the succes of this new historical opportunity. 

In my talk, I will endeavour to show how phenomenological psychopathology can be renewed by adding an ecological perspective. Integrating phenomenological psychopathology with enactive cognitive science and ecological psychology yields ecological psychopathology and psychotherapy.

Ideas on ecological psychopathology can be found in Fuchs (2007, 2019), who draws on the phenomenology of the lived body and ecological psychology with notions like phenomenal field and lived space in order to institute an ecological approach to psychic disorders and ecological psychotherapy. A similar concept that I shall highlight, the field of affordances, ties phenomenology with the ecology of an agent's interaction with the environment and can be found in the skilled intentionality framework. This ecological-enactive-phenomenological framework (Rietveld, Denys, & van Westen, 2018) sees embodied cognition as skilled engagement with affordances in the socio-material environment of the ecological niche by which an individual tends toward the optimal grip.

I will demonstrate the potency of ecological psychopathology and psychotherapy by analyzing the field of affordances of autistic persons (autism spectrum disorder). Autistic individuals are peculiar niche constructionists, and their field of affordances seems to be narrow, with shallow temporal depth and great intensity and affective salience of those affordances present. Psychotherapy would aim to restructure the disordered field of the patient in order to extend her horizon of possibilities. In the case of autism, redesigning the socio-material environment (landscape of affordances) can make it more attuned to the bodily normativity of autistic persons. 

The experience of clinical practice is foremost an intersubjective, language and bodily experience. However, we rarely observe that the effects of clinical practice consist of a mere "learning to think" or "learning to act", because this would only work if our experience were solely the result of our reflective thinking and were vertically and downwardly determined by it. On the contrary, we expect as a criterion for healing and improvement the development of another way of feeling and experiencing, far beyond a modification of reflective thinking patterns and the self-conscious direction of behaviour, namely a broader modification, which is generalised to the experience as a whole and of a more immediate, unreflective nature, in which each modification produced in the course of the treatment is worth less in itself than for its expressive value, i.e. for the modification of the subjective experience as a whole, of which it is an expression and which it carries as a condition of possibility. In this context, if the richest effects of the practice in subjective and experiential terms are generalised, unreflective and of expressive nature, how could the word and the bond with the other, the principal means of clinical experience, be precursors of such modifications? What are the noetic-noematic subjective structures presupposed by the talking cure? In this presentation, we will seek to elucidate,  from the phenomenological perspectives of Husserl and Merleau-Ponty, the structures that underlie the operation of transposition and generalisation on which the word and the transferential bond lean as a pre-condition to affect the symptom, the body and the experience. As we shall see, these structures can be analysed through contemporary approaches to the psychoanalytic transferential phenomenon, clinical cases and examples provided by fiction and literature, which will allow us to adopt an interdisciplinary approach to the question.

Kechwa is the most widely spoken indigenous language in the world. Much of the traditional medical knowledge has been lost, but current usage retains semantic content with technical implications. Traditional Kechwa medical terminology included terms used to describe psychopathology, and traditional Kechwa healers’ diagnostic consistency is comparable to modern psychiatric standards when the same patients are evaluated by both. We translated and culturally validated a phenomenology-based, bottom-up semistructured interview of psychopathology in Kechwa, with emphasis on semantic equivalence and original use/etymology of Kechwa words. We found that traditional Kechwa constructs overlap with major clinical entities in Western psychiatry, but with significant nuances in interpretation.  For instance, Taqe onqoy overlaps with mania, but the symptoms in the Andean context are seen as the expression of the vital force overtaking the person from the outside.  Taqe onqoy commonly alternates or is followed by llaqui onqoy, a widespread Kechwa condition with low mood, low energy and loss of psychosocial function.  Both diseases (onqokuna) are distinct from the term utiqay used to describe a form of madness associated with loss of touch with reality, odd behavior, and motor impairment. Utiqay-affected persons behave strangely, stand as if awe-stricken, perplexed or shocked, talk loudly to themselves, grimace without purpose and may become aggressive. Motor impairment is specific to utiqay, and is expressed as unexplained fatigue, muscle stiffness or numbness, stillness, and trouble initiating movement. These symptoms are similar to a state following extreme physical exertion (wasa utichikusqa), but occur spontaneously (“mana imamanta utichikuspa rikhureq”).  Other Kechwa words translated as madness describe transient states of trance, possession, or drug-induced behaviors occurring in the context of religious ceremonies. A behavior leading to death by consumption resembling catatonia is described under the term ayra.  Andean traditional concepts of psychopathology seem to provide accurate and detailed descriptions of psychotic disorders.

Mental health research has stagnated in recent decades, resulting in a noticeable lack of scientific progress in our understanding of diagnostics, prognostics, causation, and treatment efficacy. In response to this status quo, phenomenological psychopathology is being increasingly recognised as a viable method to re-catalyse research and clinical innovation. However, salient challenges remain to be resolved before phenomenological psychopathology can be properly integrated in mainstream psychiatry and realise its potential. These include (a) the current lack of expert-consensus on how to accurately describe the subject-matter of phenomenological psychopathology (i.e., a shared semantic framework), as well as (b) a method to capture phenomenological data such that it lends itself to scientific analyses (i.e., integration in the science of mental health). In this presentation, we showcase the Ontology of Phenomenological Psychopathology (OPheP) project, which aspires to support the integration effort by offering a decentralised, open-access, and open-source semantic framework with crucial computational properties for data capture, harmonisation, and linkage. In our talk, we shall review (1) what OPheP is as a so-called “applied ontology”; (2) how OPheP’s semantic framework is structured as a taxonomic hierarchy, where each term includes unique identifiers, definitions, synonyms, evidence, and other useful metadata; and finally (3) how OPheP will offer concrete value to working phenomenologists via its future open-source digital portal and data repository. In conclusion, we share some thoughts on how the OPheP project is construed as an antidote to the hard-learned pitfalls of other mental health resources – such as the DSM, ICD, and RDoC – which have been criticised for their inflexible top-down, centralised, and institutionalised approaches. In preparing phenomenological psychopathology for the 21st century and beyond, we believe that developing a community-built applied ontology would be a step in the right direction.