21 - Philosophical basis of psychopathology

Philosophical basis of psychopathology

© SPMM Course  The labelling model: The features of ‘so called’ mental disorders are, in fact, the response of an individual labelled as deviant (see the section on sociology above).  Hidden meaning model: Apparently irrational behaviours deemed as ‘symptoms‘ are indeed meaningful for the patient; thus they do not characterise a disorder at all.  Unconscious mind model: Apparently irrational behaviours representing ‘symptoms’ are indeed products of an unconscious process and thus can be made comprehensible (psychoanalytic view).  Political control models: The medical model of insanity is a socio-political scheme devised for the purpose of legitimizing the control of the ‘deviant, dangerous, or the undesirable’ (Also known as Foucault stance). Three major pioneers are 1. R.D. Laing, 2. Thomas Szasz and 3. Foucault. R.D.Laing wrote ‘The Divided Self’ (1959), ‘Sanity, Madness and the Family’ (1964). Thomas Szasz wrote ‘The Myth of Mental Illness’ (1961) and ‘The Manufacture of Madness’ (1971). Foucault wrote Madness and Civilization (1965). R.D. Laing famously said, “insanity need not always be a breakdown; it can also be a breakthrough”. He also said, “insanity sometimes is the sane response to an insane society.” Philosophical basis of psychopathology Human experience is varied and wide. In order to study the details of human experiences, a student of psychiatry must initially reduce such broad human experience into a simpler subject matter. Phenomenology is a method to define more clearly that which we seek to reduce, namely, the subjective essence of the given experience. (Broome, 2007) Karl Jasper: Karl Jaspers is widely considered a major figure in philosophy and psychiatry. Jaspers method of philosophical enquiry into symptoms of psychiatry has laid the foundation for descriptive psychopathology that we use today. He introduced phenomenology, a long regarded as a method of philosophic enquiry, to psychiatry. He also distinguished the difference between causal explanation (aetiology) and meaningful understanding (description) in psychiatry. In fact, he provided what Ghaemi (2007) regards as the first scientific foundation to psychiatry. The Understanding/Explanation Distinction: This dichotomy was clearly explained by Jaspers. By understanding (Verstehen), Jaspers referred to the psychological intuition that an individual could have about the meaning of a psychological state or event for another individual. By explanation (Erklären), Jaspers referred to the observable influence of one event or process on another that could be tested objectively. One can understand this distinction if one considers the

© SPMM Course fact that ‘explanation’ applies best to natural sciences (physics, chemistry, biology) and understanding applies best to human sciences (like history and art). Psychiatry requires both understanding and explanation for further study. Descriptive psychopathology differs from explanatory psychopathology in that it does not attempt to explain causality; it restricts itself to ‘understanding’ human experience through the description of what is observed. For this to be practiced, one needs a common language or terminology. By studying the glossary of psychopathology, one can prepare oneself for further enquiries in psychiatry. Hence, it is clear that there are two components in descriptive psychopathology. The initial process is one of observation of behaviour; this is accompanied by an empathic assessment of subjective experience. The latter is referred to by Jaspers as phenomenology. To describe a phenomenon, it is important to appreciate the phenomenon from the beholder’s position. This attempt to ‘feel like how your patient might feel’ is very different from feeling sorry or pitiful for your patient. The former is called empathy while the latter is called sympathy. Empathy is an essential component of learning further about the pathological processes taking place in a patient. Phenomenology purports to employ various philosophical approaches to defining the symptoms of psychiatric disorders.

1. Ostensive: illustrating a concept by clinical experience; defining by examples
2. Conventional: defining a concept using conventional description e.g. legal definitions
3. Persuasive: deliberate employment of a term to persuade users to employ it in a specific manner
4. Declarative: formal explanation of the significance of a word or its constituent parts, as used in the dictionaries
5. Contextual: defining a concept by the contexts in which it generally occurs e.g. lack of energy is related to depression
6. Essential: defining the nature of an object
7. Semantic: defining what a word means using other words

Explanatory psychopathology assumes causative factors based on theoretical constructs. Such explanations may be derived from experiments e.g. behaviourism or derived from arbitrary hypothetical theories e.g. psychoanalysis.