Eating Disorders as Disorders of Embodiment and Identity

This chapter describes the lived word of persons with eating disorders. Moving from the phenomenological perspective, it focuses on the role of the awareness and experience of one’s own body as the original anchors of the developing sense of self. It also describes a new instrument for assessment of eating disorders, based on this approach. Finally, it considers the centrality of language for body definition and its relationship with the process of identity construction. From this point of view, eating disorders can be considered as examples of psychopathology of postmodernity, in which linguistic changes and innovations of language definitions mirror the fluidity of cultural transformations and their impact on the body. Therefore, to understand the subjective world of persons with eating disorders, the phenomenological approach takes into account both the way persons speak about their body as well as the way persons perceive their own body.

The Life-World of Persons with Autism

This chapter describes some characteristics of the world of autistic people. Although these conditions are difficult to classify because of how diverse they are, this chapter reveals that there are some essential common traits. These common elements concern fundamental aspects of human intentionality, such as the preconditions of social relatedness. The chapter identifies these traits primarily through the studies conducted by Leo Kanner, who had worked contemporaneously but independently of Hans Asperger during the 1940s. Kanner identified some key features that reappeared, in different ways, in categorial definitions of autism: isolation, need for repetition, and the so-called “islets of ability.” Here, the different “autisms” are forms of existence that, for various biological reasons, develop from a fragile natural self-evidence of the inter-human world, from an original intercorporeal and interpersonal weakness. These reveal that sensory-perceptual worlds of some kind do emerge in autistic people, albeit each with its own particular features: autism, therefore, is not an “empty fortress” but rather a “full weakness.” These existential worlds involve an original difficulty in harmonizing with others, and are often difficult to grasp or imagine for those who live outside of them.

Phenomenological Psychopathology and Qualitative Research

Qualitative Research (QR) involves an interpretative approach to experimental data, generating meaning structures with specific properties. A hermeneutical approach to anomalous subjectivity is the core feature of phenomenological psychopathology, representing an excellent theoretical background for QR. In this perspective, psychiatric disorders are considered peculiar existential stances: despite all the patients’ biographical details and personal variations, they display a typical invariant structure residing in specific (anomalous) arrangements of patients’ structures of subjectivity. In phenomenological psychopathology-oriented QR, first person subjective experiences articulated in personal narratives are converted in transpersonal constructs (TPC), valid for a class of individuals—that is, people suffering from schizophrenia. TPC are synthetic schemes of comprehension of a manifold of experiences; they outline the typical invariant features of anomalous experiences, translating the first person subjective perspective in third person, objective descriptions; TPC reflect specific forms of patients’ anomalous subjectivity.They describe efficaciously the existential arrangement of people affected by specific psychiatric disorders, contributing to the fine description of clinical phenotypes. Refined TPC may be employed to draw rating scales

Schizophrenic Delusion

This chapter examines the relation, if any, between delusion and schizophrenia. The concept of delusion belongs to the semantic universe of psychopathology, whereas the concept of schizophrenia is concerned with that of nosography. In his 1889 work, Kraepelin brought together disparate syndromes, including hebephrenia and delusional syndromes, under the name of Dementia Praecox on the basis of similar outcomes. The chapter first considers some of the studies that have been undertaken to investigate the outcomes of the illness described by Kraepelin, focusing in particular on E. Bleuler’s (1911) concept of “group of schizophrenias” and K. Schneider’s claim that a diagnosis of schizophrenia is a diagnosis of the state and not of the course, and that it is to be founded on Jaspersian psychopathology. The role of autism (not delusions) as the core of schizophrenia is also discussed, along with the fundamental characteristics of schizophrenic delusions.

Phenomenology and Hermeneutics

The aims of phenomenology are to clarify, describe, and make sense of the structures and dynamics of pre-reflective human experience, whereas hermeneutics aims to articulate the reflective character of human experience as it manifests in language and other forms of creative signs. This suggests that the two approaches differ in aims, methods, and subject matter. A closer look at the two disciplines reveals, however, that in terms of history, themes, and philosophical goals they have more in common than that which separates them. This chapter examines these differences and common features in the philosophy of Heidegger and Gadamer, then demonstrates how Ricoeur’s hermeneutical phenomenology provides us with a dialectical account of personal identity that can contribute to phenomenological psychopathology. The combination of a phenomenological clarification of selfhood and a hermeneutical emphasis on interpretation paves the way for an interdisciplinary approach to mental illness.

Phenomenological Psychopathology of Neurodiversity

The term “neurodiversity” is commonly used to refer to intellectual disability or autism spectrum disorder, which are the neurodevelopmental disorders with the most severe impact on a person”s overall functioning along the life-span. Although a wide interpersonal variability, these conditions are associated with peculiarities in the subjective existential experience and in the psychological insight, with a particular reference to areas of emotionality, spirituality, practical skills, socialization, and psychic suffering. These peculiarities lead to a complex psycho-physical continuous vulnerability, including neurovegetative dystonia, lack of environmental mastery, low coping, difficulties in self-determination, repeated losses, and societal exclusion. Care provision should aim at improving quality of life, by enabling the “neurodiverse” (or “psycho-characterized”) person to pursue a self-development aimed at optimizing the relationship between importance and satisfaction in the most emic areas of life, such as being, belonging, and becoming.

Vital Anxiety

Anxiety is an ambiguous word, it is used to describe a feeling, a clinical symptom, but it is also a disorder or a group of disorders (anxiety disorder). Anxiety is related to our intimate relationship with ceasing to exist, with nothingness, with the limits of human beings. The problem of anxiety is intimately related to hope, because there is no human or psychological situation worse than despair. To know the meaning of anguish and anxiety helps to know mankind. From a phenomenological perspective, vital anxiety is a vital feeling, with the same characteristics as other vital feelings such as those of well-being, discomfort, or vertigo. They are feelings that express our way of “being in the world”. In this chapter, the concepts of anxiety and phenomenology of vital anxiety will be reviewed, as well as the point when a normal feeling turns into a pathological one, because the transition between a vital or mood feeling is of psychopathological interest and it is important to understand mood and anxiety disorders.

The Experience of Time and its Disorders

The chapter first introduces a phenomenological concept of temporality, referring to time as pre-reflectively lived vs. consciously experienced. Lived time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative-affective dynamics of life on the other hand. Experienced time, for its part, results from an interruption and desynchronisation of lived time. It unfolds into the dimensions of present, past and future, leading to autobiographical time and finally to narrative identity. On this basis, major psychiatric disorders such as schizophrenia, melancholic depression and obsessive-compulsive disorder will be presented as paradigm cases for a psychopathology of temporality.

Introduction

This introductory chapter discusses the primary focus of psychiatry and how phenomenological psychopathology in particular serves as the basis for psychiatry. It argues that psychiatry is not only a biological discipline. It must maintain an intense concern with the quality of patients’ experiences by focusing on the “psyche” and not just the brain, which is of interest to psychiatry only insofar as it helps one better understand the relevant psychic phenomena. Thus, one must investigate the relationship between these subjective experiences, the brain, and the way we classify psychiatric disorders. In this light, phenomenological psychopathology becomes increasingly central to these discussions. At present, the psychiatric study of psyche and subjectivity is defined mainly by changes in experience and behavior. Therefore, psychopathology, the discipline that assesses and makes sense of the suffering psyche, is at the heart of psychiatry.

On the Subject Matter of Phenomenological Psychopathology

This chapter provides a framework for the phenomenological study of mental disorders. The framework relies on a distinction between (ontological) existentials and (ontic) modes. Existentials are the categorial structures of human existence, such as intentionality, temporality, selfhood, and affective situatedness. Modes are the particular, concrete phenomena that belong to these categorial structures, with each existential having its own set of modes. In the first section, the chapter articulates this distinction by drawing primarily on the work of Martin Heidegger—especially his study of the ontological structure of affective situatedness (Befindlichkeit) and its particular, ontic modes, which he calls moods (Stimmungen). In the second section, the chapter draws on a study of grief to demonstrate how this framework can be used when conducting phenomenological interviews and analyses. In the concluding section, the chapter explains how this framework can guide phenomenological studies across a broad range of existential structures.